Surgery for an enlarged prostate

introduction

Due to the anatomical position of the prostate directly around the urethra, it occurs sooner or later in most cases in patients who suffer from an enlarged prostate Obstruction of urine flow. The problems that arise when urinating are on the one hand simply uncomfortable, but on the other hand they can also cause subsequent problems. This includes above all Bladder stones, Urinary tract infections or Kidney damage.

Accordingly, surgery is often necessary after a conservative attempt at therapy. A distinction is made between procedures in which the prostate is completely or partially removed from those in which an improvement in symptoms is achieved through minor surgical or physical measures. The prostate tissue can be treated in such a way that it can then be broken down by the body itself

There is a further subdivision with regard to the selected access. On the one hand, the prostate can "transurethral", so through the urethra operated as a natural access route. On the other hand, there are also access routes through the abdominal wall possible. Can these prostate removal procedures not be used, e.g. Due to many previous illnesses, there is also the possibility of opening the urethra yourself Stent keep open.

Transurethral prostate resection

For transurethral prostate resection (TUR prostate) the prostate is removed by the urethra. this is that current standard procedures for the therapy of prostate enlargement and has been used for a very long time. This is a endoscopic instrument brought in. This can then be used to remove the prostate tissue using a bipolar electrical incision. This has the advantage that there is hardly any bleeding.

It is also possible by means of a sling to salvage ablated tissue and so histopathologically further to examine. Since the operation is performed under sight with the help of the endoscope, surrounding tissue can be spared. Also injuries to the bladder sphincter that lead to long-term Incontinence can be avoided. Usually a long-term improvement of the symptoms and especially of the urine flow can be achieved.

necessary.

Transurethral prostate incision

In this procedure, the urethra is also chosen as a natural access route. In contrast to the prostate resection described above, however, the Leave the prostate on its own. Instead, they are attached to the capsule and tissue of the prostate, as well as the bladder neck small incisions performed. This method is particularly suitable if there has been a narrowing in the area of ​​the bladder neck Prostate itself is rather small. Although the procedure causes fewer complications immediately after the operation, there is a long-term risk that further constrictions will occur if the prostate continues to enlarge. The main areas of application are young, sexually active men with only a very small enlarged prostate.

Open surgical prostatectomy

As the name suggests, it is open here through the abdominal wall and then operated on through the bladder, or between the bladder and pubic bone. This procedure is except for extremely enlarged prostate or other individual factors such as the presence of Diverticula or at one Inguinal hernia, hardly used anymore. As you can imagine that is Complication rate through the ultimately cumbersome access route here a little bit higherthan with access through the urethra. The improvement in symptoms and long-term complications, however, are roughly the same.

Laser therapy

Lasers can be used in various ways in treating enlarged prostate. Since the way in which a laser acts on a tissue, as well as the depth of penetration depends heavily on its wavelength, it is possible with the laser to do both to cut, as well as the tissue to melt down.

In the Vaporization the prostate is melted down and the constriction is eliminated. However, the procedure has the disadvantagethat no cutting samples more can be extracted for pathological examinations. This is especially bad if it can only be clarified during the operation whether it is a benign prostate enlargement or one tumor acts.

That is what this is for cutting laser processeswhich that gentle removal made possible by tissue, but does not melt it down immediately. Samples can also be taken with a laser-assisted procedure. The laser has established itself especially in forms of prostate enlargement, which previously required an open surgical procedure.

Laser coagulation

Another method is what is known as laser coagulation. The laser is introduced through the dam. The prostate is not actually removed. Rather, the tissue of the prostate is destroyed by the laser in a way through which it is subsequently removed Body degraded itself can be. In the process, the tissue initially swells, followed by remodeling and finally degradation processes. The results can roughly be compared with those of transurethral prostatectomy (TUR prostate). However, since the procedure is less invasive, it is particularly suitable for patients for whom an actual operation would not be possible.

Other ablative procedures

In addition to laser coagulation, there are a number of other procedures that are intended to improve the symptoms without actually removing the prostate. This includes e.g. the transurethral mirowave thermotherapy, in which the prostate is treated with the help of microwaves and a water-cooled catheter. This procedure, however, mainly treats the symptoms and less of a urinary flow disorder. The works in a similar way transurethral needle ablation, in which the prostate is heated with an inserted needle. Both procedures show a very low complication rate and can also be carried out on an outpatient basis without anesthesia. Because of the small effect on the obstruction of the urine flow, another operation is often necessary a few years later.

Complications

Regardless of the procedure, there are a number of complications that can arise after surgery on the prostate. In addition to the normal surgery and the risk of anesthesia, this includes above all Secondary bleeding and Discomfort when urinating. Also erectile dysfunction can occur as a complication, but often exists before the procedure. A renewed formation of bottlenecks and thus a possible new operation cannot be ruled out either. A phenomenon that occurs in the majority of those who have been operated on after TUR is the so-called "dry ejaculation". The ejaculate is not transported outwards during ejaculation, but in the direction of the urinary bladder. However, this does not affect the libido or the feeling during orgasm