Prostate surgery

Surgery on the enlarged prostate is a surgical procedure that is becoming increasingly common.

The clinical term for benign enlargement of the prostate gland is benign prostatic hyperplasia (BPH) or prostate adenoma, which means that the enlargement is not caused by some type of tumor.
In men, this is a common disease of the prostate, from which almost all men suffer in old age.
According to reports, men over the age of 60 are more prone to this problem.

Today, with the new “nerve sparing” technique, side effects such as erectile dysfunction and incontinence can almost always be avoided.
This variant of prostatectomy has the advantage of preserving the integrity of the nerves.


Possible surgeries to treat prostate enlargement

The procedures used in the operation are set out below:

Transurethral resection of the prostate
A traditional type of surgery for prostate enlargement is transurethral resection of the prostate (TURP).
If the gland has enlarged, it presses against the bladder and thereby causes annoying urinary symptoms.
TURP is an operation performed through the urethra that serves to interrupt excessive growth of prostate tissue pressing on the bladder, relieving pressure and symptoms.
This surgical procedure is painless because the patient is under general anesthesia.
In some cases, only the lower part of the patient’s body is anesthetized.
The duration of the procedure is about 1 hour.
Hospitalization lasts about 1-2 days.
After the procedure, the doctor inserts a catheter, otherwise the swelling would stop the flow of urine.
In most cases, men experience a full recovery after a few days.

Transurethral incision of the prostate
Another surgical option for prostate enlargement is the transurethral incision of the prostate (TUIP).
This type of intervention is considered safer than the one described above for the following reasons:

  1. Less blood loss.
  2. Minimal hospital stay – TUIP can be done on an outpatient basis, although some men have to stay in the hospital all night for observation.
    TUIP can be the safe surgical solution if the patient has major health problems.
  3. Lower risk of retrograde ejaculation – There is less chance that sperm will be expelled into the bladder during ejaculation (retrograde ejaculation) than in the other prostate surgeries. This does not cause health problems, but can prevent fertilization.

Thus, people who are not suitable for TURP or who have been diagnosed with moderate enlargement of the prostate can be treated according to the method of TUIP.
In contrast to TRP, this procedure does not remove the excess tissue, but only one or two small incisions are made in the prostate gland with a laser or electric current.
This is intended to relax the opening of the bladder, in this way the resistance to the flow of urine to the outside is reduced.
How long does the operation take? The TUIP procedure takes about 20-30 minutes.

Radical prostatectomy as open surgery
In some people, the prostate is so enlarged that it cannot be treated with TURP or TUIP. Thus, the surgeon makes a lower abdominal incision to get to the diseased prostate. Therefore, the procedure is called prostatectomy in open surgery. After the incision, the outer part of the gland is removed.
This procedure carries a high risk of complications and is therefore only used in men with a high-grade prostate enlargement.
Usually, such a procedure takes about 2 hours, but in some cases it can take even longer.

Robotic surgery on the prostate

A robotic prostatectomy is a surgical procedure in which prostate cancer is removed by making small incisions with high precision with the help of robotic devices.
During the procedure, the surgeon preserves the three most important areas for sexual function and urine control:

  1. Urinary sphincter
  2. Pelvic floor belt
  3. Neurovascular bundle

In the following, this procedure is compared with other prostatectomy techniques.

One of the main benefits of robotic prostatectomy is less pain and scarring because it is a minimally invasive procedure.
Plus, it’s a particularly good option for people who have low hemoglobin levels, as it results in less blood loss than the traditional surgeries.
The surgeon pumps gas into the abdomen, which has a higher pressure than the veins. For this reason, bleeding is reduced.
The magnification of the images by ten times compared to the normal size and the three-dimensional vision improve the precision of the surgeon.
Robotic surgery of the prostate is the only treatment for prostate cancer that:

  • completely removes the gland,
  • guarantees the achievement of a PSA level of almost zero.

Furthermore, in a robot-assisted prostatectomy, the inpatient stay for the patient is much shorter.

One of the advantages of prostate surgery performed with the Vinci robot is the early removal of the catheter only seven days after the procedure.
In an open prostatectomy, this is removed after 1-2 weeks.

After surgery:

  1. 96% of patients can regain bladder control in just 2-3 months;
  2. 85% regain sexual potency in 12-24 months.

On the other hand, there are reports of people complaining of side effects after surgery such as:

  • Incontinence
  • Problems with sexual intercourse.

However, it is only possible to judge whether sexual health is impaired or not if at least one year has passed after the operation.

Prostate surgery with green laser

This procedure is carried out using a laser for benign prostate enlargement. This laser fiber is inserted through the urethra using a cystoscope, and when it reaches the prostate, it emits a high-intensity laser beam.
The heat generated by this laser radiation is very intense, so only the excess prostate tissue is heated and evaporated (becomes water vapor).
This therapy is performed under spinal anesthesia and lasts about 30 minutes.

There is a new laser technique that consists of photoselective vaporization of the prostate (PVP).
In this treatment, the absorption of laser energy is carried out by hemoglobin, resulting in strong cell heating.
The result is the vaporization of the tissues and blood vessels and therefore there is no bleeding.

Surgical intervention to treat prostate enlargement by laser is less invasive than the procedures described above.
Therefore, it is suitable for people who are too weak for surgery where there is a risk of high blood loss and for patients whose prostate enlargement is rather mild.
As the name suggests, a high-energy laser is used to remove the tissue that has exceeded the normal extent.

Since this procedure is short-lived, the patient does not need to stay overnight in the hospital.
Thus, the recovery time is much shorter than with traditional surgical surgery.

The surgeon inserts a catheter to allow urine to leak.
This can be removed after about one or two days.
One of the biggest advantages of this outpatient method is that the condition of people with prostate enlargement improves almost immediately after laser therapy.
This is in contrast to conventional open surgery, which may take a long time before the results occur.
With this method, there is little blood loss, because the laser causes immediate clotting; therefore, this is the preferred option for men with:

  • blood clotting disorders,
  • Cardiovascular problems.

Although there are some possible side effects with this procedure, they are mild. After this procedure, there is less than 1% chance of sexual dysfunction.
The reason for this is that, unlike open surgery, in this procedure, the nerves and blood vessels in the area around the bladder are not at risk, as this surgical procedure is extremely precise.

There is a procedure known as transurethral microwave therapy (TUMT) that shrinks the organ. In the process, internal parts are destroyed and thus the flow of urine is facilitated. In this case, microwave energy is used. TUMT is usually performed under general anesthesia and in just one session.

Transurethral needle ablation (TUNA) is a procedure that sends radio waves into the tissue using a few needles inserted into the prostate. These waves heat and scar the prostate tissue, shrinking the prostate and thus simplifying the exit of urine. Hospitalization is not required and the procedure can be performed under local anesthesia. This option is particularly suitable for people who:

  • are slightly prone to bleeding,
  • suffer from other diseases.

Prostate surgery HIFU

High-intensity focused ultrasound (HIFU) is a form of surgical intervention that consists in destroying part of the prostate by ultrasound by raising the temperature of the cells, thus killing them.

Side effects of prostate surgery

Discomfort during urination
You see this side effect in many people who undergo surgery on the prostate, especially in the first few months.

Erectile dysfunction
Erectile dysfunction is another significant side effect that many men suffer from.
This occurs because surrounding nerves of the prostate are removed during the procedure.
However, therapies are available to treat erection problems or impotence.
A solution to the problem can be a penile prosthesis, which is a structure consisting of 3 parts:

  • Cylinder
  • Pump
  • Reservoir

The prosthesis allows a complete erection by making fluid flow by pressing a button located on the pump.
In the same way, you can let the penis relax again.

Intestinal dysfunction (rare)
In addition to urinary and erection problems, surgery on the prostate can also lead to disruption of intestinal function. This side effect arises due to damage to the rectum.

and bleeding 
Pain and bleeding are very common side effects seen in many patients undergoing surgery.
Normally, pain, bleeding and swelling disappear after a few weeks or months.
However, some alternative therapies may be needed if pain and bleeding don’t stop.

Retrograde ejaculation
During ejaculation, the bladder neck must close so that the fluid of the prostate gland can be expelled and pass through the urethra.
In retrograde ejaculation, the bladder neck remains open and the sperm mistakenly enters the bladder instead of the urethra, where it mixes with the urine.
The final excretion of the semen then takes place via the urine.
This is one of the rarer side effects and is believed to cause no damage.

Infertility can be a side effect of surgical prostate surgery.
In addition to retrograde ejaculation, the procedure on the prostate can damage the nerves that allow an erection.

Recovery after prostate surgery

Postoperative course
If a patient undergoes prostate surgery for cancer, the length of hospitalization depends mainly on:

  • type of operation,
  • State of health after surgery.

For recovery after surgery, a catheter is placed for urine outflow until the patient can urinate completely normally.
Healing after surgery occurs faster if the patient follows the main instructions:

  1. avoid lifting heavy objects for a few months,
  2. healthy diet based on fruits and vegetables,
  3. drink enough water.

Recovery after prostate surgery with the laser

Convalescence after laser prostate treatment can take 7 to 15 days.
When the procedure is finished, doctors recommend complete rest for a few days.
The prescribed medications include antibiotics and painkillers, which must be taken as directed.
During convalescence, one should avoid any kind of arduous activities such as running, weightlifting, sports and driving, as they can worsen the situation. During the recovery period after surgery, complications could occur such as:

  • Necessity of frequent micturition
  • Formation of blood clots (thrombi) in legs or arms
  • Narrowing of urethra or bladder neck
  • Burning sensation when urinating
  • Blood in the urine

Recovery after robot-controlled prostate surgery

Recovery after robotic surgery takes less time than the other types of surgery.
Just a few hours after the operation, many people can walk around and in a few days they can go back to their normal daily activities.
The reason for this is that the many incisions are small and pressurized gas is used to limit bleeding.
Already one day after this procedure, the discharge from the hospital takes place.

Incontinence after prostate surgery

Types of incontinence after prostate surgery:

  • Urge incontinence: Urge incontinence is a type of urinary incontinence in which urine leaks unintentionally due to an involuntary bladder contraction.
  • Stress incontinence: Stress incontinence is a type of incontinence in which there is a slight leakage of urine every time the person sneezes, coughs, or when any stress affects the bladder.
  • Mixed incontinence: Mixed incontinence is a combination of urge incontinence and stress incontinence. As a rule, the symptoms of this type of incontinence are more severe.

Stress incontinence is the most common form of unwanted urinary discharge in men after prostate surgery.

Therapy for urinary incontinence
There are gymnastic exercises such as those of Kegel that help strengthen the necessary muscles to stop the flow of micturition.
There are many other preventive measures that can be taken, including restricting drinking diuretic substances such as alcohol, caffeine, etc.

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