The appointment of laser enucleation of prostate adenoma and the course of the procedure. Transurethral enucleation of the prostate (tueb) - a new method of bipolar endoscopic surgery for BPH

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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 moment.

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.

The test is loading...

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!

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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.

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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

Of all the existing methods of surgical treatment, laser enucleation of prostate adenoma is the most preferred. This is due to the peculiarities of the operation, which minimizes the risk of complications. Patients choose this procedure for quick recovery and high efficiency.

Laser enucleation of prostate adenoma is a minimally invasive operation that allows you to remove only the tissue of benign hyperplasia. The prostate capsule is not damaged during the procedure. Enucleation does not affect healthy tissues of the organ.

The essence of the procedure is the layer-by-layer burning of overgrown tissues with the help of a holmium laser and their subsequent removal from the urinary tract. There are no scars, no incisions are made. Access to the organ is transurethral.

A special endoscope equipped with a camera and a device for delivering laser radiation is inserted into the patient's urethra. The image is displayed on the monitor, which allows you to follow the operation during its execution. First, the doctor uses a loop to separate the adenoma tissue from healthy prostate tissue. Then radiation is applied, with the help of which the adenoma is removed.

The whole procedure takes no more than two hours. The duration of the operation depends on the size of the adenoma - it takes about 40 minutes to remove a small tumor, and about 120 minutes for a large adenoma. The main stage of rehabilitation after removal of the adenoma takes several days. Then, for some time, the patient should follow the recommendations of a specialist.

If tissues are evaporated during laser vaporization, then during enucleation the laser cuts them off, then they are crushed and brought out

Indications for carrying out

Laser enucleation is a method of treating adenoma, so it is the diagnosis of "benign prostatic hyperplasia" that is the main indication for the procedure.

Removal of prostate adenoma is the most effective method of treatment. Conservative or medical methods can stop the progression of the disease, however, after a while, for each patient, the question of the need for an operation becomes acute. Thus, an operation to remove an adenoma is indicated in the following cases:

• ineffectiveness of medical treatment;
• large size of the tumor;
• sexual dysfunction due to adenoma;
• obstruction of the urinary tract;
• the risk of complications on the kidneys due to adenoma.

According to men who have undergone an operation to remove an adenoma, after rehabilitation, the quality of life changes significantly for the better. After removal of the adenoma, the process of urination is quickly normalized, sexual function is restored, and the pain syndrome disappears.

Enucleation is preferred in the following cases:

• large size of the tumor;
• contraindications to other types of operations;
• blood clotting disorder.

There are several methods for removing an adenoma. All of them are accompanied by bleeding, therefore, are contraindicated in patients with impaired blood clotting. In addition, not all minimally invasive methods are used for large tumor sizes (more than 100 cm 3).

Laser enucleation is the only method that allows you to remove a large adenoma without the risk of bleeding. If a man takes drugs that thin the blood, and the withdrawal of drugs during the preparation for surgery and the rehabilitation period is impossible, laser enucleation becomes the only possible method of surgical treatment. In addition, the age of the patient is not a contraindication to the procedure; enucleation is prescribed even for men over 75 years of age.

The method is suitable for removing adenomas of any size

Advantages of the method

Like any other treatment method, laser enucleation of an enlarged prostate or benign prostatic hyperplasia has its advantages and disadvantages. Advantages of the method:

• the effectiveness of the result does not depend on the size of the adenoma;
• no age restrictions;
• minimal risk of complications;
• fast recovery.

The main advantage of the method is minimal blood loss due to simultaneous coagulation of vessels in the process of excision of tumor tissues. This makes it possible to carry out enucleation even in violation of blood clotting. Unlike other methods, enucleation is equally effective for small and large tumors.

The method is less traumatic, the procedure is painless. Usually, sparing options for anesthesia are used during the operation, so that enucleation can be performed without risk in elderly men.

Of particular note is the rapid recovery. Full recovery occurs within a few weeks. The first improvements are noticeable already on the second day after removal of the adenoma. After removing the catheter, the patient no longer experiences problems with urination.

Disadvantages of the method

Despite everything, the method still has disadvantages. The main disadvantage is that the effectiveness of the procedure depends on the professionalism of the surgeon performing the operation. Before burning the tumor with a laser, the doctor must separate the lobules of the prostate gland. The laser is not selective, so a great responsibility falls on the shoulders of the surgeon. If the adenoma is not completely removed, there is a risk of its re-development.

Another disadvantage is the high duration of the operation. This is true only in cases where a large tumor is to be removed.

The high duration of the procedure and dependence on the professionalism of the doctor determine the high cost of the procedure. Laser enucleation of prostate adenoma is an operation on the prostate gland, the cost of which depends, first of all, on the size of the tumor. In Russia, Ukraine and Belarus, the cost of the procedure is on average equivalent to 1,000 euros. In Russia, prices start at 50 thousand rubles. In Moscow clinics, the operation is more expensive, in the provinces - cheaper.

In European clinics, laser enucleation of an adenoma starts from 10 thousand euros, in South Korea - from 4 thousand dollars.

The main disadvantage of the method is the high cost.

Carrying out enucleation

Enucleation is prescribed by a doctor after a series of examinations. The decisive study that allows you to make a decision in favor of enucleation is a blood test for PSA. To determine the volume of the adenoma, the method of transrectal ultrasound diagnostics is used. Examination of the kidneys and bladder is mandatory to exclude secondary pathologies, urinary tract obstruction and urethral stricture.

Preparation before the operation

Preparatory measures are reduced to the revision of the drugs taken by the patient. If a man is shown long-term treatment with anticoagulants, it is necessary to additionally consult with the specialist who prescribed such treatment. Despite the absence of bleeding during laser enucleation, it is recommended to stop taking drugs that affect blood clotting. Unlike other adenoma removal methods, laser enucleation allows the abolition of medications that a man must take constantly, for just a few days.

Also, the patient should consult with the anesthesiologist and choose the method of anesthesia for the duration of the operation.

In most cases, transurethral laser enucleation is performed under epidural or spinal anesthesia. Such methods of anesthesia are better tolerated by the body than general anesthesia. If there are contraindications to partial methods of anesthesia, it is possible to perform the procedure under general anesthesia.

The psychological state of the patient also plays an important role in choosing the method of anesthesia. If a man is very nervous and in a state of stress, general anesthesia may be prescribed.

The procedure itself is performed on an empty stomach. There are no strict dietary guidelines before surgery. A light dinner is recommended the day before, the operation is performed only on an empty stomach.

Operation

The surgeon sees all his actions on the monitor

After anesthesia, a special tool is installed in the man's urethra. At this time, the image is displayed on the monitor, which allows the doctor to monitor the progress of the operation. The surgeon then separates the tissue to be removed by the laser. In several stages, the laser separates hyperplasia tissue from healthy prostate tissue. These fragments are crushed and excreted through the bladder. During tissue separation, laser coagulation of the vessels occurs. They are literally soldered, which avoids bleeding.

After the entire adenoma is removed, the man is placed in a catheter, which remains for 12-24 hours. With the help of a catheter, urine is drained until the man can empty his bladder on his own. Usually the catheter is placed at night and removed in the morning.

The length of stay in the hospital is no more than three days. The rules of rehabilitation boil down to the fact that a man consumes a large amount of fluid. This is necessary to restore normal urination. In the early days, pain may be present, which is explained by a violation of the tone of the bladder.

Rehabilitation

Full recovery takes about 4 weeks. In the first few days, the man remains in the hospital. The absence of concomitant health problems allows the patient to be discharged after a day. In this case, you will have to spend only one night in the hospital.

Rehabilitation comes down to the following:

• increased fluid intake;
• lack of physical activity;
• sexual abstinence;
• balanced diet.

In the first 4 weeks, you need to take care. During this time, physical activity should be avoided. Doctors also advise abstaining from sexual intercourse for the first month.

A strict diet after removal of the adenoma is not prescribed, however, it is necessary to eat right to avoid the development of constipation.

Possible Complications

Laser enucleation is considered a relatively safe procedure. Complications occur very rarely. These include:

• urinary incontinence;
• hematuria;
• infectious inflammation of the genitourinary system;
• erectile dysfunction.

Urinary incontinence in the first days after surgery should not disturb the patient. As the tone of the bladder is restored, this violation will pass. It is also possible to increase the pressure of urine and the appearance of pain in the urethra.

Hematuria on the first day is normal, but if blood in the urine is observed a few days after the operation, you should consult your doctor.

Erectile dysfunction in the first weeks should not worry the patient. This is an absolutely normal reaction of the body to surgical treatment. The erection will be restored by the end of the rehabilitation period.

If you have a urinary tract infection after surgery, you should consult with a urologist. In this case, antibiotic therapy is mandatory.

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Patient P., 67 years old.

Diagnosis: prostate hyperplasia II stage.

Clinical manifestations of the disease: frequent, difficult urination lethargic jet, at night up to 2-3 times.

Brief data of the anamnesis: during the last five years notes the deterioration of the quality of urination. Examination at the polyclinic at the place of residence revealed hyperplasia (adenoma) of the prostate. For two years he has been taking omnic without a significant positive effect.

Blood and urine tests without significant deviations from the norm. PSAtotal - 1.3 ng / ml.

Ultrasound examination: kidneys and bladder without pathological changes. The prostate gland has a volume of 88 cm3. protrudes into the lumen of the bladder by 1.5 cm. Hypoechoic areas are not determined. With CDI, the blood flow in the prostate is evenly distributed, there are no areas of pathological vascularization.

With ultrasonic voiding cystourethroscopy: the prostatic urethra is deformed, narrowed by nodes of prostatic hyperplasia.

With uroflowmetry: the maximum rate of urination is 7.4 ml / s, the average is 3.2 ml / s with a volume of 148 ml. Residual urine 95 ml.

In order to restore adequate urination, the patient underwent laser enucleation of prostate hyperplasia.

During the operation, 56 g of adenomatous tissue was removed. The postoperative period proceeded smoothly. The urethral catheter was removed on the first day after the operation. Independent urination was restored in full. At the control ultrasound, there is no residual urine, the maximum urination rate is 27.3 ml/s.

The patient was discharged from the hospital in a satisfactory condition on the third day after the operation.

Operated

PhD Sorokin Nikolai Ivanovich Ph.D. Dymov Alim Mukhamedovich.

Laser enucleation of prostate adenoma

People diagnosed with benign prostatic hyperplasia (hereinafter referred to as BPH) patients can benefit from the most advanced treatment method, namely the holmium laser for enucleation. This method allows you to remove not only a small tumor and at the same time avoid many postoperative consequences and complications that often accompanied this disease in the past.

This enucleation operation is a transurethral way to remove the prostate using a laser and an endoscopic camera. The new technique has become widespread in gynecology, urology and otolaryngology. It allows you to effectively dissect and reject internal tissues. It is used in medical practice as a way to treat patients who have severe pathologies.

Doctors have been practicing treatment of BPH sufferers using this laser for quite a long time, more than 10 years. Only recently, medical equipment has been updated, has undergone progressive changes, including surgical equipment using a laser. This made it possible to expand the range of applications of the laser, and due to the availability of the method, to increase the number of patients who used it.

Advanced surgical equipment has greatly increased the possibilities of treating patients and not only with BPH. Thanks to him, it became possible to do not only standard conventional irrigation of tissues with a jet from a vaporizer, but also to perform a complete resection of the affected tissue.

Enucleation of the prostate, together with the method of fragmenting the entire gland into fragments, helps to remove prostate tumors, even quite large ones. It was this method that made it possible to avoid open adenomectomy, a more dangerous complete removal of the prostate gland.

Laser enucleation of BPH: what happens during surgery?

An operation to remove a tumor of the gland with a laser is performed by passing an endoscopic camera through the urethra. Using the camera, the doctor can see the entire course of the operation using a special device. A laser is attached to this camera, inserted through the urethra through a special channel. With the help of a laser, the damaged parts, and sometimes the entire prostate gland, are removed.

This method provides minimal intervention in the patient's body. During the surgical treatment, the integrity of the capsule around the gland is preserved. The surgeon introduces a laser and cuts off the lobes damaged by the tumor. Then these parts are crushed into smaller fragments to make them easier to extract.

At the end of surgery, a catheter is inserted into the bladder to help It was excrete urine. The catheter stays for a day, then it is removed.

The operation can be performed under general anesthesia or with epidural anesthesia. Both methods of anesthesia block pain.

The operation is carried out quite quickly, its duration is approximately 1-2 hours. After extraction, the fragments are sent to the laboratory for analysis.

Such a study is done in order to exclude a malignant modification of the removed tumor. If the study reveals the presence of malignant cells, more serious treatment is required, for example, chemotherapy or radiotherapy.

What are the complications after laser enucleation?

Since such an operation belongs to minimally invasive surgical methods of treatment, after it, as well as after other similar operations, the risk of complications is much lower than after direct surgical intervention. However, they still exist. The most common are:

temporarily there is the effect of urinary incontinence; frequent urination, accompanied by burning; the appearance of blood in the urine; damage to the bladder; erection dysfunction;

Like every technique, this method has its advantages and disadvantages.

What are the advantages and disadvantages of this treatment method?

Advantages of minimally invasive treatment:

The undoubted advantage is the most effective result of the procedure. studies have shown that the level of safety when using this method is minimal. there are no restrictions on the size of the gland. blood loss accompanying holmium enucleation of prostate hyperplasia is quite insignificant. during surgery, the risk of invasion is reduced to a minimum. most often, surgical treatment with this method is well tolerated, as evidenced by studies and statistics. after surgery, bladder catheterization is not more than two days, which is the minimum indicator. hospitalization for no more than two days, after which, if no other problems are observed, they are discharged from the hospital.

After the treatment, the body quickly recovers and there are no relapses. In addition, there is a pronounced almost instantaneous effect.

A significant disadvantage of adenoma enucleation with a laser can be called, first of all, the cost of this operation, since it requires special expensive equipment. It should also be noted that this is a technically complex operation and will require a responsible approach from the doctor and the availability of appropriate skills.

Despite the fact that surgical removal of a hyperplastic gland is currently the only truly reliable way to combat the clinical signs of this pathology, the patient still does not receive guarantees of a complete cure.

There are a number of risks of surgical complications, which may result in, for example, an erection problem. However, these risks are minimal and with a competent approach of doctors, it is unlikely that a person will encounter such complications.

However, it should be noted that 10% of patients a few years after enucleation of BPH come back with a recurrent problem. Sometimes there are still cases of damage to the urethra and its subsequent narrowing or weakness of the bladder develops, which entails the re-insertion of the catheter.

Alternatively, drug therapy, the installation of a urethral stent, and some other methods of treatment are possible.

These articles are just as interesting, be sure to read them:

Laser surgery for prostate adenoma

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The most advanced methods of surgical treatment of prostate adenoma is laser surgery. This technology uses a high-energy laser to destroy the overgrown prostate tissue. Modern leading clinics use holmium-niodymium lasers from Lumenis (USA), which allow performing radical operations with pinpoint accuracy and reduce the patient's stay in the hospital to one day. In Ukraine, such a laser is located in the Spizhenko Cyber ​​Clinic, Kyiv, and you can find out about the conditions of treatment at the link

The main advantages of laser surgery include:

Low risk of bleeding; low invasiveness (intervention) and good tolerability of the operation Short period of bladder catheterization after the operation (no more than 24 hours); short hospital stay (1-2 days) and fast rehabilitation (no more than a week); rapid onset of effect after surgery; high efficiency of the method

There are two main types of laser prostate surgery:

Laser ablation - burning the overgrown prostate tissue to increase urethra passing through the prostate. Laser enucleation - removal of all obstructive tissue, as in open surgery (adenomectomy), but with a lower risk of complications.

Laser ablation (removal) methods include:

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Photosensitive vaporization (evaporation) of the prostate. In this method of laser surgery, laser energy at a high temperature is used to heat and vaporize the overgrown prostate tissue. This is a more gentle method in which blood loss is minimized. The absence of the need to use hypotonic solutions dangerous for the body used for washing the bladder allows the operation with an adenoma mass of 60 cm3 to 140 cm3. This method is more preferable at a young age when it is necessary to maintain sexual function. Holmiev - laser ablation (removal) of the prostate gland (HoLAP). HoLAP is similar to the previous method except for the use of a different laser source. This laser can also be used to treat bladder, kidney, urinary tract tumors, as well as to remove kidney stones. HoLAP and other laser ablation methods show good results in small prostate adenomas.

Interstitial Laser Coagulation (ILC)

With the help of a laser, incisions are made and the destruction of prostate tissue in order to form scars. These scars reduce the prostate gland, while increasing the lumen of the urethra and improving the outflow of urine. This procedure is usually recommended for those who have small to moderate BPH. Improvement in well-being can come through long a period of time, since the effectiveness of interstitial laser coagulation depends on the body's ability to heal wounds created deep in the prostate gland. This procedure is less effective and there is a possibility that a second treatment will be required.

Laser enucleation

The advantage of Laser enucleation is the ability to remove large prostate adenomas, as in open adenomectomy, but with minimal consequences.

Laser enucleation methods include:

Holmium laser resection of the prostate (HoLRP). The laser is injected into the penis and with the help of a resectoscope, the gland tissue is removed in small pieces. This method is now rarely used, it has been replaced by newer methods. Holmium laser enucleation of the prostate (HoLEP). This procedure is similar to HoLRP but uses an instrument (morcellator) to grind the tissue into small fragments. HoLEP can be used for any size of prostate adenoma. HoLEP has the best results of all existing methods. However, this method is complex, requires a highly skilled surgeon and is used only in large clinics.

The advantages of laser enucleation methods over laser ablation methods are as follows:

The removed prostate tissue may be examined. It is possible to make sure that there are no signs of prostate cancer. No need for re-treatment. (This is a controversial statement, since the technologies are quite new and not time-tested)

What to think about

Surgical treatment is the most reliable way to eliminate the symptoms of prostate adenoma. But the operation does not guarantee complete relief. Still, there are risks of surgical complications, including problems with erection (erectile dysfunction). Other complications may include involuntary urination (urinary incontinence) and ejaculation of semen into the bladder rather than out through the penis (retrograde ejaculation). Complications depend on the type of surgery used.

Men who have more severe symptoms often notice a significant improvement in their quality of life after surgery. Others, in whom the symptoms are mild, find that the operation did not bring significant relief. Therefore, one must think carefully before deciding to undergo surgery to treat BPH.

If you decide to have surgery, or if there are clear medical reasons for having surgery, then the best surgical outcome will depend on the size and shape of your prostate and the experience of the surgeon. π

Before we talk in detail about the methods of treatment, briefly about the symptoms and diagnosis of prostate adenoma, in order to avoid confusion, we will make a reservation about the terms denoting this ailment, the so-called adenoma and benign hyperplasia prostate (BPH) are the same disease. Adenoma is a benign growth of the central parts of the prostate gland, which is not a cancerous (malignant) tumor.

So, let's start with a short description of the functionality and anatomy of the "second heart" of a man. The main function of the prostate gland is secretion, the release of seminal fluid involved in the transport and nutrition of spermatozoa during ejaculation. In order to understand the structure of the gland, let's compare it with a peeled orange, only in the area of ​​\u200b\u200bthe core passes the urethra, the tube is the urethra, so the slices of the orange (lobes of the prostate) seem to wrap around this tube from all sides.

The gland itself is located under the bladder. With age, the prostate tissue begins to grow, this growth is primarily due to the fact that the prostate itself is a hormone-dependent organ. And with age in the body of any man there is a number of changes in his hormonal status. As a result, the nodes of hyperplastic tissue of the prostate begin to squeeze the urethra, thereby leading to a violation of the act of urination.

REMOVAL OF PROSTATE ADENOMA WITH A HOLMIUM LASER

The method allows the surgeon using modern expensive endoscopic equipment without a single incision, bringing the laser fiber to the prostate along the urethra, and begin its gradual removal. At the same time, unlike transvesical adenomectomy, the likelihood of intraoperative complications with holmium enucleation (holep) is minimized. The surgeon controls and clearly sees both the area of ​​the cut and every movement of his instrument. The technique is the most effective and safe, and in a number of indicators has surpassed even the gold standard in the treatment of prostate adenoma - TURP.

I would like to note the fact that the removal of adenoma by resection of the prostate (TUR) or laser enucleation ( holep) through the urethra does not lead to sexual dysfunction, which very important for sexually active patients. The operational benefit itself is carried out under safe anesthesia, the length of the patient's stay in the hospital is on average about 3 to 7 days.

Method of laser enucleation of prostate adenoma (holep) used in our clinic since 2009 Specialists have accumulated extensive experience in performing this kind of endourological aids, which can significantly reduce the likelihood of complications, both during surgery and in the postoperative period.

Transvesical adenomectomy "blindly"

The oldest method of getting rid of a patient from adenoma was the technique open transvesical adenomectomy. The method is certainly effective, but very traumatic, since tissues are dissected during access, the bladder is opened, and the main stage of adenoma isolation by the surgeon is carried out almost blindly, by touch. all this leads to the occurrence of undesirable consequences and complications, including urinary incontinence, dry orgasm, erectile dysfunction, severe intraoperative bleeding, etc.

Plus, the allowance implies a long stay in a hospital, established drainage into the pelvic cavity, increase the risk of purulent-septic complications. The method in the conditions of our center is carried out exclusively according to indications, the minimum number of patients, the main of which is the size of the gland more than 80-90 cm3.

We strongly recommend that you do not postpone a visit to the urologist if a number of the symptoms and complaints described above have already been outlined. If nothing bothers you and you are over 45, be sure to donate blood for PSA (an oncological marker of prostate cancer), and at least once a year make an unexpected visit to your specialist - a urologist.

Minimally invasive surgical methods are highly effective: they reduce the patient's recovery time and reduce the risk of postoperative complications. Laser enucleation of prostate adenoma is used in the treatment of a benign tumor of medium and large size, which cannot be removed by evaporation or ablation.

What is the method of enucleation of prostatic hyperplasia

Laser enucleation of prostatic hyperplasia involves the complete removal of the prostate gland without violating the integrity of the capsule. After excision of tissues, they are divided into small particles and removed from the body.

Indications for HoLEP:

• Inefficiency.
• Problems urinating, up to a complete stop of urine excretion.
• Large amount of hyperplasia.
• Contraindications for abdominal resection.

Of course, as in the case of any other surgical intervention, direct prerequisites are necessary for the appointment of laser enucleation. For this reason, treatment is prescribed only after a thorough differential diagnosis.

Equipment involved in the method

• Laser machine - equipment is better known under the abbreviation HoLEP. Unlike similar installations used for and , the laser power was significantly increased, which made it possible to completely excise the patient's gland, and not just remove it in small layers.
• Endoscope - all equipment for laser enucleation of the prostate is brought through the cavity of the tube. The endoscope is inserted through the urethra or rectum, directly into the prostate gland.
  Urethral therapy will require a small incision in the internal tissues, no more than 1-1.5 cm. Surgical instruments and a video camera are delivered to the incision site through the internal cavity of the endoscope.
• Video camera - the surgeon maintains visual control over the operation, which reduces the percentage of errors to a minimum.
• Surgical instruments - a set is used to carry out the operation. The tissues of the excised prostate are taken to the bladder, after which they are removed with a morcellator (a device for grinding and removing large particles).

The difference between laser vaporization of the prostate and enucleation

• The purpose of the operation is during vaporization, the main task of the surgeon is to reduce the volume of the prostate gland, while the procedure is aimed at separate overgrown areas. During enucleation, the adenoma is completely removed.
• Possibility of carrying out additional diagnostic researches. During evaporation, tissues shrink in volume but remain inside the body. It is impossible to examine samples for the nature of education.
  HoLEP removal of prostatic hyperplasia with a laser is associated with the removal of whole tissues, crushed to the required size. After surgery, specimens can be examined for malignancy.
• Efficiency - with vaporization, in 20% of cases, a second operation is required. After HoLEP removal, recurrence occurs no more than 1 in 100 cases.

Advantages and disadvantages of laser enucleation of BPH

Advantages of the method:

• The ability to remove the prostate of any size.
• Minimal blood loss - during tissue dissection, simultaneous coagulation of blood vessels occurs.
• High clinical efficiency and safety for the patient. The use of a holmium laser for prostate enucleation significantly reduced the risk of postoperative complications.

• The dependence of the result on the professionalism of the surgeon performing the intervention.
• Duration of enucleation - the procedure is carried out within 2-3 hours.

Stages of treatment of prostate adenoma with a holmium laser

• Without the effectiveness of drug therapy.
• Pain and problems with urination.
• No contraindications to therapy.

Stages of preparation for enucleation of BPH

• Preparing the body - a week before surgery, stop taking anticoagulants and other drugs that thin the blood. Immediately before the procedure, the patient's condition is assessed for contraindications to enucleation.
  The anesthesiologist selects the optimal type of anesthesia. On the day of the operation, the operated person is advised to refuse to eat.
• Psychological preparation - clinical safety studies show that laser enucleation is the most sparing of the existing methods of radical treatment. Despite this, most patients experience discomfort and psychological rejection of the procedure.
  Before prescribing treatment, the urologist provides the necessary assistance to the patient, describing the method and explaining how enucleation works.

Anesthesia is chosen taking into account the psychological state. During the operation, spinal (local) anesthesia is sufficient, but general anesthesia is allowed.

What happens during enucleation of prostatic hyperplasia

• Bipolar enucleation - has a minimal risk of postoperative complications, while approximately 5-8% less efficiency, manifested in a larger volume of residual urine and an increased likelihood of recurrence.
• Monopolar enucleation - is considered the standard of the operation, as it gives a long and long-term effect. Possible complications in the form of bleeding, temporary erectile dysfunction.

• Install the endoscope.
• Bring the video camera and laser to the prostate gland.
• If transrectal surgery is performed, an incision is made in the tissues of the rectum.
• The prostate is cut out with a laser.
• Parts of the tissue are retracted into the bladder. With the help of a marcellator, the pieces are crushed and excreted from the body.
• After tissue removal, coagulation is carried out. Damaged blood vessels are sealed with a laser.

Postoperative stage of treatment of prostate adenoma by enucleation

The operated person is advised to drink plenty of fluids. Small remnants of excised tissue remain in the bladder and urethra. To avoid sepsis of the body, it is necessary to remove them naturally. To do this, you need to drink 2-3 liters of water daily.

Removed after 1-2 days, depending on the progress of the recovery. In the first few days, there is an increased urge to urinate, bleeding is possible. If there is residual pain, an anesthetic is prescribed. If blood is found in the urine for more than 48 hours, you should consult a doctor.

What complications can you face

There is a possibility of the following complications after performing HoLEP:

• Burning sensation when going to the toilet. The symptom is temporary and usually resolves within a week after surgery.
• Frequent urge to urinate, urinary incontinence. Unpleasant sensations stop as the work of the muscular system of the pelvic organs is restored.
• Reoperation is rarely required. Usually, medical non-surgical treatment is sufficient.
• Erectile dysfunction - if the patient had no problems with potency before the operation, then after the removal of the gland, problems with sexual life should not arise.
• Dry orgasm is one of the common problems. The patient, after the operation, is able to experience an orgasm, but no sperm is released. Getting pregnant with this diagnosis is possible only with the help of artificial insemination.

The surgeon will warn the patient before the operation about possible complications and ways to prevent them.