Operation of prostatitis: from simple to complex
Currently, there are many different approaches to the treatment of prostatitis.
At a very advanced stage of the disease, with the progression of the disease with the formation of an ulcer (abscess) in the prostate, as well as the formation of strictures and cysts, raises the question of operative treatment. In this situation, to cure prostatitis only an operation will help, she is able to give high guarantee the successful resolution of the encountered pathological process.
Indications for surgical intervention
The complications that surgical treatment include:
- Narrowing (obstruction) of the urethra to the size at which urination becomes almost impossible. A similar condition appears when joining the prostatitis, phimosis, that is impossible to open and expose the head of the penis men.
- In violation of the outflow of secretions through seminal vesicles, which occurs when inflammation.
- Abscess of the prostate gland (the appearance of pustules on the surface of the prostate).
- In the case of sclerosis of the prostate gland or adenoma.
- If an enlarged prostate causes bleeding, acute delay of urine outflow, kidney failure. Surgery is necessary for frequent urination at night, which disturb the quality of life of the patient, and if the amount giperplazirovannah prostate is more than 80 cm3.
- No surgical intervention is necessary and in the presence of partial blockade of the urethra, as it leads to infections of the urinary tract, disease of the bladder or the formation of stones.
- Paradoxical ischuria – involuntary urination in a crowded or stretched bladder.
There are other indications for surgical intervention, which is individually determined by the attending physician.
Types of surgery for prostatitis:
Transurethral resection of the
Closed removal of the prostate gland. The operation is performed with the use of a tube that the surgeon inserts through the urethra without cutting the abdomen. Transurethral resection is performed under local anesthesia.
When the anesthetic takes effect, the surgeon through urethra inserts a thin optical fiber which is equipped with special electronicam (loop of wire, through which electric current is applied).
This knife, the doctor cuts the prostate tissue that blocks the opening of the bladder. Then the separated portion is pushed into the bladder by the injection into the urethra of glycine, extracted out and sent to the survey for microscopic diagnosis.
For the private removal of partprostate cancer, like any other surgery, some risks and complications that you should know each patient.
The risk of surgery is associated with possible complications from anesthesia, bleeding while urinating, and in the area of the procedure, difficulty urinating due to the formation of blood clots, shortening of the urethra and bladder infection.
In rare instances there is a loss of control over the flow of urine and complications in the genital area (retrograde ejaculation or impotence).
Sometimes patients after surgery, there is the so-called "symptom TURP" which appears as a result of absorption of fluid (glycine) for washing, which is used during the resection. Symptom TURP has the following symptoms: violation of electrolyte balance, deteriorating health, etc.
Transurethral resection is performed under local anesthesia – spinal or epidural. A drug that inhibits pain sensitivity, the anesthesiologist injected into the spinal canal through the intervertebral space.
Anesthesia causes loss of mobility and sensation in the lower back, allowing the surgeon to work freely, and the patient during surgery not feel pain.
During epidural anesthesia, the specialist makes the injection into the cavity which is located below the spinal canal. The injection contains the minimum number of active substances, so throughout the procedure at the injection site you must have a catheter, which gives the opportunity to control the quality of anesthesia.
Spinal anaesthesia is more prolonged and deeper than an epidural, is that pain medicine is injected by one injection into the spinal canal with the spinal fluid.
Transurethral incision of the prostate
In addition there is a transurethral resection of incising the prostate. This type of surgery is considered more effective for men with enlarged prostate is little gland. Compared with resection, this procedure produces less complications and a shorter recovery period.
The surgeon at carrying out this type of operation makes two cuts along the prostate near the bladder neck. Cutting the muscles in the prostate in this area significantly weakens the squeezing of the urethra, as with TURP.
Open surgery in which the surgeon makes the complete removal of the prostate. The technique of this operation is quite difficult and traumatic, often accompanied by great loss of blood.
In radical prostatectomy the surgeon makes a longitudinalan incision in the lower abdomen in the bladder. Then produces an incision of the bladder wall and mucosa around the prostate, then removes the prostate.
Then a specialist is the restoration of the integrity of the urethra. In the urethra catheter is found for the formation of a wall around it, it will self-withdraw urine. Typically, such a catheter remains for a period of 7 to 10 days. Wound of the bladder and the abdomen sutured.
This complication more often associated with the failure to comply with the rules of asepsis during or after the surgical procedure. After prostatectomy the patient with the purpose of prevention of infection antibiotics are appointed.
Development of complications is accompanied by malaise, fever and pain.
After operations in the neck of the bladder where the prostate was, it leaves a wound and an empty space. In the postoperative period if not stop the bleeding, it may continue.
To prevent this complication the surgeon into the bladder enters the Foley catheter, at the end of which is flaring spray. After the introduction of the catheter, the balloon is filled with a special solution and pressed against the wound.
The formation of stricture of the urethra
In the place where before the surgery was the prostate, there is a narrowing, and in some cases fusion of the lumen of the urethra. The complication mainly is manifested by a delay in the outflow of the urine, and difficulty urinating.
To prevent the attending physician recommends to the patient in the postoperative period to drink more liquid. This prevents the splicing of the urethra and leads to an increase in urination. Stricture of the urethra is a very serious complications and sometimes requires additional surgery.
Preparation of the patient
Preparation for the surgical intervention is the traditional examination, which includes the study of urine and blood samples. The anesthesiologist examines the patient and discusses the forthcoming anesthesia.
In prostatectomy patients are given General anesthesia or regional anesthesia in which medication is injected with a needle into okolovenoznoe space.
Special attention in the preparation of the patient for surgery give bowel cleansing. To do this the night before the procedure is enema.
Contraindications to surgery for prostatitis
- acute diseases of individual organs and systems;
- severe General condition of the patient;
- acute inflammationin the urinary system;
- presence of diseases with blood clotting disorder and condition in which it becomes impossible to perform surgery as planned (poor mobility of the hip joints, etc.).