Even a few decades ago the only possible way to remove adenomatous nodes with BPH had an open prostatectomy.
After this surgery there were many complications. Because of volume, large blood loss, the need for a long stay in the anesthesia and serious rehabilitation, this method approached not for all men. Adenoma of the prostate – a disease of elderly patients, and many have chronic disorders that increase the risk of unfavorable outcome.
Patients with serious illnesses was a palliative surgery – epicystostomy in which the urine was derived into a special drainage bag to the drainage tube.
The situation has improved with the advent of alpha-blockers, inhibitors of 5-alphareductase and implementation of a transurethral resection.
Currently, operations associated with high risk, rarely performed, they were replaced by minimally invasive surgery, allowing the treatment of BPH by laser.
The patient’s age and large prostate volume (up to 200 cubic cm) is no longer an obstacle to surgical treatment, and the list of contraindications has decreased significantly.
Types of lasers in urology, possible intervention
For the normalization of the outflow of urine on the background of obstruction of the lower urinary tract for BPH used the holmium, tolevy and green laser.
Depending on power, the laser can cause coagulation (necrosis) and vaporization (evaporation) of tissues.
Each laser beam there are nuances in the work, tolevy gives a more dense energy flow. It is believed that it is less traumatic for the tissue than the holmium. In fact, and in another case, the risk of bleeding is minimal, and the recovery period does not imply a complicated rehabilitation. There is evidence that the tissue healing after laser tulawaka better.
Laser enucleation of the prostate
When using tulawaka laser operation is called tulieva enucleation of the prostate (ThuLEP). Iron of almost any size to be removed.
Holmium laser enucleation (HoLEP) is similar in technique and efficiency with folievoy in major urological hospitals is also used widely. Suitable for a large prostate volume.
Laser ablation
Laser ablation of the prostate – the burning laser – interference prostate with a volume of up to 30 cm cube, when the manipulation is removed only the “extra” tissue that impede the flow of urine.
Vaporization of the prostate with green laser (photoselective vaporization)
Tissue of the prostate with vaporization (evaporation) green laser layers are burned by the high temperature exposure. The intervention involves a thermal burn (the temperature reaches several hundred degrees) adenomatous nodes and vaporization of tissues. The prostate volume should not be more than 90 cm cube.
Laser photocoagulation
Laser photocoagulation is another method of treating BPH, the thermal influence leads to the necrosis temperature less than the vaporization – 60-70 C.
Contraindications
Prostate cancer laser treatment is not performed, as the tumor process can begin to progress.
Other contraindications:
- diseases of cardiovascular system, liver and kidneys in the stage of decompensation;
- pathology of blood coagulation;
- acute inflammatory process;
- fever of any origin.
Why modern surgery for adenoma better
- During prostatectomy is completely removed gland, erectile function after surgery organogenesis suffered greatly (85%), which in some cases required a penile prosthesis. When surgery laser sexual dysfunction to occur in 2-9% of patients.
- Laser treatment is often directed only to the expanded tissue, preventing the flow of urine, it is possible to save on hardware.
- The laser beam because of the high accuracy and control does not damage the surrounding tissue.
- Swelling is less pronounced, which allows you to start to urinate on their own for 24-48 hours.
- The risk of bleeding, compared with prostatectomy, is much lower, less than 1%.
- The need for re-manipulation is less than 2%.
- The rehabilitation period is shorter.
- There are no incisions.
- The length of the expected effect of the operation is 12-15 years.
What are the necessary examinations before removal of the adenoma laser
Sometimes, to clarify the diagnosis, perform magnetic resonance imaging and transrectal biopsy for suspected prostate tumor.
What happens when you laser removal of the adenoma, and after
In laser surgery whatever laser beam destroys the prostate tissue.
Deletions in the bladder is crushed using a special tool morcellator.
Mandatory after extracting the biomaterial is transferred to histological and cytological study in order to exclude a malignant process.
All manipulations are carried out without performing incisions, endoscopic instruments are inserted through the urethra. Control is carried out with the help of endoscopic optics, or the image is broadcast on the screen.
As a method of pain relief, often performed spinal anesthesia, during the surgery, the patient is awake.
The duration of the surgical treatment of BPH by laser depends on the amount of gland, type of operation, but not more than 60-120 minutes.
After completion of the bladder Foley catheter set with several channels. One is a continuous outflow of urine, and the other serves saline. This is necessary to prevent the formation of blood clots, which can cause hemotamponade with acute urinary retention.
Drainage is removed after 24-48 hours, the patient was observed for several days (in private clinics may be released on outpatient treatment immediately after the restoration of normal urination).
For comparison: after the TURP (transurethral resection of the prostate) drainage reserve up to 5 days, while the open prostatectomy up to 7-9.
The results of morphological study, the patient can return after 10-12 days. According to medical statistics, in 3-5% of cases are diagnosed prostate cancer. In this case, oncomethylome is defined further tactics of reference.
What can be complications after removal of BPH laser
The frequency of complications after laser treatment less than after TUR and prostatectomy. But, like any surgical intervention, after laser removal of prostate possible side effects:
- reflux of semen into the bladder;
- inflammation;
- obstruction of the lower urinary tract with the need for repeated surgery;
- the development of fibro-sclerotic processes;
- urinary incontinence;
- trauma to the urethra, the bladder neck.
Rehabilitation after treatment of BPH with laser
On the first day may cause blood clots ranging in size from 1 to 4 mm in the urine. This process is not considered a pathology.
Low-grade temperature (not above 37, 3) valid for 1-2 days, fever with chills implies immediate consultation and strengthening the antibiotic treatment.
To prevent the accession of secondary microflora prescribed antibiotics and abundant drinking regime – up to 2-2,5 liters per day.
After 8 hours after surgery you can eat, but spicy, sour, salty and smoked food should be abandoned. In the diet useful to include foods rich in fiber, this will help to avoid constipation.
After leaving the hospital should be observed in outpatient urologist: once every 7-10 days to perform a General analysis of blood and urine, liver function tests, urea and creatinine.
Do not skip doses of your medications specified in the statement is not independently change the dose and the duration of the course. If there are any symptoms of trouble immediately inform the doctor, without waiting for the date of the next appointment.
Sexual life can be resumed not earlier than after 4-5 weeks when the urine and the General condition normalized.
Stimulants of potency may provoke bleeding. Sexual intercourse should not be too long.
In the first weeks after treatment of BPH with laser may not have control over urination. The doctor will prescribe special medication and exercises (Kegel exercises).
Prohibited heavy lifting (no more than 4 kg), hard sports; from visiting saunas and baths, swimming in pools and pools should be abandoned.
A feasible exercise, Hiking will help to recover faster.
