The medical term that defines the enlarged prostate is benign prostatic hyperplasia (BPH) or prostate adenoma, it means that the swelling is not due to a type of cancer . 
In men this disease is one of the most common and almost all men suffer from benign prostatic hyperplasia when they get older. 
Reports say that men over 60 are the group most prone to this problem.

Today, with the new technique “Nerve Sparing” it is possible to avoid almost always the side effects like problems of erectionand incontinence . 
This variant of prostatectomy surgery has the advantage of maintaining nerve integrity.

 


Possible surgical procedure to treat enlarged prostate

The procedures performed in the context of surgery are briefly explained below:

Transurethral Resection of the Prostate
One type of traditional surgery for the enlarged prostate is transurethral resection of the prostate (TURP). 
When the gland increases, it presses against the urinary bladder which causes irritating urinary symptoms. 
RTU is an operation performed by the urethra and serves to help stop the overgrowth of prostate tissue pressing against the bladder, relieving pressure and symptoms.

This surgical procedure is painless because the patient is under general anesthesia . 
In some cases, the anesthesia is done only on the lower half of the patient’s body. 
The duration of the operation is about 1 hour. 
After surgery, the doctor inserts a catheter because otherwise the swelling will block the flow of urine. 
In most cases, after a few days, men are able to have a full recovery.

Transurethral Incision of the Prostate
Another surgical option for prostate enlargement is the transurethral incision of the prostate (ITUP). 
This option is considered safer than above because:

  • Causes less blood loss,
  • Minimal hospitalization  – TUIP can be done in the day hospital, although some men may need to stay in the hospital for observation throughout the night. 
    TUIP may be a safer surgical option if the patient has major health problems.
  • Less risk of retrograde ejaculation – there is less chance of emitting spermatozoa in the bladder during ejaculation (retrograde ejaculation) than other interventions in the prostate. This does not cause health problems, but can prevent fertilization.

Therefore people who are not considered suitable for TURP or those with a moderate prosthetic increase are treated with ITUP. 
Unlike TURP, this operation does not eliminate excess tissue , but performs one or two small incisions in the prostate gland with a laser or electric current. 
This serves to relax the opening of the bladder, in this way the resistance to the flow of urine to the outside is reduced.

How long it takes? The duration of the ITUP operation is approximately 20/30 minutes.

Radical open prostatectomy (open surgery) . 
In some people, the gland increases so much that it is not possible to cure with TURP or ITUP. Then in these cases, the surgeon makes an incision in the lower abdominal region to access the diseased prostate. 
For this reason, the procedure is known as open prostatectomy. 
After the incision is made, the external part of the gland is removed. 
This surgery involves a high risk of complications and therefore applies only to men with a severe prostate enlargement. 
Usually the duration of this surgery is about 2 hours, but in some cases, it may be longer.

 


Robotic surgery of the prostate

A robotic prostatectomy is a surgery that removes a prostate cancer, performing small cuts with high precision with the help of robotic equipment.

During surgery, the surgeon maintains the three most sensitive areas of sexual function and urinary control:

  1. The urinary sphincter,
  2. The endopelvic fascia,
  3. The neurovascular bundles.

The duration of the intervention is about 1.5 hours and the patient is discharged the next day. 
Below is a comparison of this surgery with other prostatectomy techniques.

Advantages
One of the major advantages of robotic prostatectomy is less pain and scarring because it is a minimally invasive procedure. 
In addition, this is an especially good option for men who have low hemoglobin levels  because there is less blood loss than traditional surgical operations.

The surgeon pumps gas into the abdomen with a higher pressure compared to the venous. For this, the bleeding is reduced. 
Magnifying the image up to 10 times normal size and three-dimensional vision improves the surgeon’s accuracy.

Robotic prostate surgery is the only treatment for prostate cancer that:

  1. Completely removes the gland,
  2. It guarantees a near zero PSA level.

In addition, in the case of a robotic prostatectomy the time that the patient should remain in the hospital is much lower.

One of the advantages of prostate surgery with the Da Vinci robot is the early withdrawal of the catheter, just seven days after surgery. 
In the case of open prostatectomy, removal occurs 1-2 weeks later.

After the operation:

  • 96% of patients regain control of the bladder in only 2-3 months,
  • 85% regain sexual power in 12-24 months.

Disadvantages
On the other hand, there are some reports of people who after undergoing this surgery complain about side effects like:

  1. Incontinence,
  2. Problems in sexual intercourse.

However, to judge whether sexual health is compromised or not, after surgery should wait at least a year.


Prostate surgery with green light laser

This procedure is performed with the aid of a laser for benign prostatic hypertrophy. 
This fiber laser is inserted into the urethra through a cystoscope and when it reaches the prostate it emits a high intensity laser light. 
The heat generated by the laser beams is very intense and therefore heats the prostate tissue that vaporizes (becomes water vapor). 
This treatment is performed under spinal anesthesia (spinal anesthesia) and lasts about 30 minutes.

There is a new laser technique consisting of photoselective vaporization of the prostate (PVP). 
This treatment involves the absorption of laser by the hemoglobin, therefore a strong heating of the cells takes place. 
The consequence is the vaporization (evaporation) of the tissues and blood vessels and therefore there is no bleeding.

Laser surgery to treat prostatic hyperplasia is relatively less invasive than the procedures described above. 
That is why it fits people who are too weak to face a surgery that has a risk of abundant blood loss and for those with a moderate increase in prostate. 
As the name implies, the procedure uses the high energy laser to remove tissue that has exceeded normal size.

Advantages
Since this procedure is brief, it is not necessary for the patient to spend the night in the hospital. 
Therefore the recovery time is very short compared to traditional surgery.

The surgeon inserts a catheter to allow the emission of urine. 
The catheter can be removed within a day or two.

One of the major advantages of this outpatient procedure is that people with an enlarged prostate improve almost instantly after laser therapy . 
This is in contrast to traditional open surgery surgeries that may take a long time to show results. 
In this procedure, there is minimal blood loss  because the laser causes an immediate coagulation, so it is the preferred option for men with:

  1. Coagulation problems,
  2. Cardiovascular disorders.

Although there are some side effects for this surgery, they are very mild. After this procedure there is less than 1% chance of erectile or sexual dysfunction. 
This is because unlike an open surgery in this procedure, the nerves and blood vessels present around the bladder are not at risk because of the high accuracy of this surgery.

There is a procedure known as transurethral microwave thermotherapy (TUMT)that reduces this organ, destroying the inner part, facilitating the flow of urine. 
In this case the microwave energy is used. 
It is usually performed with a general anesthesia and can be completed in a single session.

Transurethral Needle Ablation (TUNA) is a procedure that sends radio waves that reach the prostate tissue with the help of some needles inserted into the prostate gland. 
These waves heat and heal the prostate tissue, decreasing the prostate and facilitating the release of urine. 
It does not require hospitalization and can be done under local anesthesia. 
This option is suitable for patients:

  • Susceptible to bleeding ,
  • They suffer from other diseases.

 

HIFU

HIFU (High Intensity Focused Ultrasound) is a type of surgery that involves the destruction of a part of the prostate with the application of ultrasound that increases the temperature of the cells, causing death.

 


Side Effects of Prostate Surgery

Urinary dysfunction
This side effect is seen in many people who undergo prostate surgery, especially in the first few months.

Erectile Dysfunction Erectile
dysfunction is another important side effect that affects many men. 
This is because during surgery the nerves near the prostate are removed. 
However, there are some therapies available to treat erectile dysfunction or impotence. 
A solution to the problem may also be the inflatable penile prosthesis, i.e. a structure consisting of 3 parts:

  • Inflatable Cylinders
  • Scrotum pump
  • Reservoir.

The prosthesis can achieve a complete erection of fluid movement by pressing a button on the bulb. 
Likewise, you can return with the flaccid penis.

Intestinal (rare)
dysfunction In addition to erectile and urinary dysfunction, bowel dysfunction may be a consequence of prostate surgery. We can see this side effect due to damage to the rectum.

Pain and Bleeding
Pain and swelling are common side effects seen in many patients who undergo surgery. 
In normal cases, pain, bleeding, and swelling disappear after a few weeks or a few months. 
However, some alternative treatments may be needed if the pain and bleeding does not stop.

Retrograde
ejaculation During ejaculation, the bladder neck must be closed to allow the delivery of prostatic fluid through the urethra. 
In case of a retrograde ejaculation, the cervix remains open and the sperm enters incorrectly into the bladder rather than into the urethra and is mixed with the urine. 
The final exit of the semen is through the urine. 
This is one of the rarer side effects and is believed to do no harm.

Infertility
Infertility can be one of the side effects of prostate surgery. 
In addition to retrograde ejaculation, prostate surgery can damage nerves that allow a man to have an erection.

 


Recovery after prostate surgery

Postoperative course
In the case of a patient who underwent surgery for prostate cancer, the length of hospitalization depends mainly on:

  1. Of the type of surgery,
  2. Of the state of health after the surgery.

In postoperative recovery, a catheter is used to hold the patient’s urine until the urine flow returns completely to normal.

Recovery after surgery is faster if the patient follows vital instructions, such as:

  • Avoid lifting heavy objects for a few months,
  • Maintain a healthy diet based on fruits and vegetables,
  • Drink plenty of water.

 

Recovery after laser surgery

Convalescence after a laser treatment can last from 7 to 15 days. 
When the operation is completed, doctors recommend full rest for a few days. 
Medications include antibiotics and analgesics that can be taken as directed. 
During convalescence, it is necessary to avoid any kind of heavy activity, such as running, bodybuilding, sports or driving. 
This may aggravate the situation. During recovery from surgery, complications such as:

 

Recovery after robotic prostate surgery

The recovery of a robotic prostate surgery takes less time than other types of surgeries. 
Even after a few hours of the operation, many people can walk and in a few days it becomes possible to perform normal daily activities.

This is because the incisions are very small and the gas under pressure is used to limit bleeding. 
Just one day after this procedure, you may be discharged from the hospital.

 


Incontinence after prostate surgery

Types of incontinence after prostate surgery

  • Urge incontinence Urge incontinence is a type of urinary incontinence in which there is an involuntary loss of urine due to involuntary contractions of the bladder.
  • Stress incontinence : Stress incontinence is a type of incontinence where there is a slight loss of urine when a person sneezes, coughs or when there is some kind of pressure on the bladder.
  • Mixed Incontinence : Mixed incontinence is a combination of stress incontinence and stress incontinence. Generally, the symptoms of this type of incontinence are more serious.

Stress incontinence is the most common type of urine leakage in men after prostate surgery.

 


Treatment for urinary incontinence

There are fitness exercises known as Kegel exercises that help strengthen the muscles used to stop the flow of urination. 
There are many other preventative measures you can take, including drinking less diuretic substances such as alcohol, caffeine, etc.

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