When should I
consider surgery?
1. When your lower urinary tract symptoms get worse, even
if you are already receiving drug treatment
2. When you have complications of BPE/BPH or if you are
at risk of getting them. Complications include:
·
Kidney failure
·
Dilatation of your
kidneys
·
Inability to urinate
(urinary retention)
·
Recurring urinary
tract infection
·
Recurring blood in
the urine
3. If you do not tolerate drug treatment very well
4. If you prefer surgery over drug treatment (due to poor
compliance with drugs)
During most of the surgical treatment, the urologist, will
remove the enlarged part of your prostate (also known as adenoma). There are
different types of surgical procedures, but all of them aim to relieve your
symptoms and improve the flow of urine.
What are various
procedures for surgical treatment of benign prostatic enlargement?
The main procedures are:
·
Transurethral
resection of the prostate (TURP)
·
Transurethral
incision of the prostate (TUIP)
·
Prostate stents
·
Open prostatectomy
·
Laser treatment
Each procedure has its own advantages and disadvantages.
The choice of treatment depends on your individual situation, preference and
expertise of a surgeon. This section offers
brief information about various conventional surgical treatments and detailed
information about laser treatment for benign prostatic enlargement.
Transurethral resection of the prostate (TURP)
TURP is the standard surgery for BPE/BPH. The aim is to
remove the part of the prostate which causes the symptoms. The procedure is
done through the urethra without making an incision in your lower abdomen. This
type of surgery is known as minimally invasive treatment.
Transurethral
incision of the prostate (TUIP)
TUIP is effective in men with prostates smaller than 30 gms.
TUIP is recommended if you cannot tolerate drugs for BPE symptoms. During TUIP,
the doctor cuts into the prostate through the bladder neck to improve the flow
of urine.
Prostate stents
Prostate stents are used to keep the urethra open which
improves the flow of urine. Stents are mainly recommended for men who are not fit
for surgery but who are still able to empty the bladder on their own. They are
used instead of an indwelling catheter.
Open prostatectomy
Open prostatectomy is an operation which is done by
making an incision in the lower part of the abdomen. Because TURP/Laser
prostatectomy has similar or better results, open prostatectomy is very rarely done
in selected situations.
Laser treatment is a common treatment option for BPE/BPH.
The laser uses intensive light to cut or vaporize the prostate tissue. At the
same time, the heat from the laser is used to close blood vessels. This is why
only a small amount of blood is lost during this type of surgery.
There are two main types of laser surgery for BPE:
1. Laser vaporization of the prostate
2. Laser enucleation of the prostate
These types of surgery can be done with different laser
systems. The choice of the laser depends on the expertise of your doctor and
what is available in the hospital.
Laser vaporization of
the prostate
How is laser
vaporization performed?
For laser vaporization, patient will receive general or
spinal anesthesia. Once patient are under anesthesia, the doctor uses a resectoscope
to enter the bladder through the urethra without making an incision in your
lower abdomen. The resectoscope has a laser for vaporization and a small
camera.
During the procedure, the laser heats up a small part of
the prostate. When the tissue reached boiling point it starts to vaporize. In
this way, the whole prostate can be treated. After the operation, a urinary
catheter will be placed in your bladder to drain urine. You will need the
catheter for one or two days until the urethra is partly healed and you can
urinate on your own.
When should I
consider laser vaporization of the prostate?
Vaporization may be an option if your prostate is smaller
than 80 to 100 gms. Because vaporization causes very little blood loss, it is
recommended for men who need to take blood-thinning medication for other
conditions.
How long will it take
me to get back to my daily activities?
Usually patient can leave the hospital 1 or 2 days after
surgery. The length of hospital stay can vary in different situations. There
may be some blood in your urine and you may feel pain when you urinate. This
can last up to several weeks and not considered abnormal after such kind of
surgery.
What are the advantages
of laser vaporization of prostate?
·
Immediate improvement
of the urine flow
·
Short hospital stay
·
Shorter period of
using a catheter
·
Low risk of
complications
·
No need to stop
blood-thinning medication
Disadvantages of
laser vaporization
·
Less effective for
very large prostates
·
Painful urination for
some time after the surgery
·
May need another
surgery after several years because the prostate continues to grow
·
No possibility to analyze
the prostate tissue after the surgery
·
Very low risk of urinary
incontinence
How is laser
enucleation performed?
For laser enucleation, anesthesia, position of patient
and instruments are the same as laser vaporization of prostate. It requires a
different laser (i.e. holmium or thulium laser) compared to laser vaporization (i.e.
KTP laser). During laser enucleation, the urologist uses the laser to cut
prostate tissue and in this way the whole prostate can be treated. The doctor
then uses an instrument known as morcellator to flush the cut tissue out of
your body through the bladder and the urethra.
Postoperative management and stay remains same as in
laser vaporization of prostate
When should I
consider laser enucleation of the prostate?
If your prostate is over 80 to 100 gms, laser enucleation
may be the best option for you, because it removes the whole adenoma. This type
of surgery is also a good option for men with prostates smaller than 80-100gms.
Laser enucleation is suitable for men who take blood-thinning medication for other conditions. It is important to discuss your individual situation with your doctor.
Advantages
of laser enucleation
·
Immediate improvement of the urine flow
·
Short hospital stay
·
Shorter period of using a catheter
·
Low risk of complications
·
Effective for all prostates, especially for
large ones
·
Possibility to analyze the prostate tissue
after the surgery
Disadvantages of laser enucleation
·
Painful urination for some time after the
surgery
·
Very low risk of
urinary incontinence
Comments
Post a Comment