All about prostatectomy, its conduct, consequences and recovery
The prostate gland is a major organ, but in some cases the only salutary solution to his withdrawal. Removal of the prostate (radical prostatectomy) is a surgical operation involving the complete removal of the prostate gland (if necessary, together with the lymph nodes).
Most often removal of the prostate shows if a person is diagnosed with cancer of the prostate (much less in the case of BPH).
In the early stages of prostate cancer are asymptomatic, later cunningly disguised as disorders of urination, characteristic of an adenoma, so often men go to the doctor when the process has spread beyond the prostate, tumor metastases (III-IV stage of cancer. Here to full recovery, however. The course is a surgical scalpel, but the removal is performed mainly with the aim of eliminating the difficulty of outflow of urine.
However, the introduction of a combination of digital rectal examination and determination of PSA (prostate-specific antigen in the blood) led to a revolution in early diagnosis of cancer (stage I and II). PSA present in the blood of healthy men in small quantities and with age growing: the more, the worse the prognosis. Normal PSA is 3.5 ng/ml (men 45-55 years), and if the value is increased to 10 ng/ml the probability of cancer is approximately 50%. The growth rate increased and the ratio of bound and free PSA is what helps to make a diagnosis and draw a conclusion about the feasibility of the operation.
Thus, due to the diagnosis of NMC has increased the number of cases of detection of localized prostate cancer, long before its obvious manifestations. At this stage, the removal of the prostate can lead to complete removal of tumor with minimal risk of a relapse.
There are several methods for performing prostatectomy:
- Open prostatectomy
- Laparoscopic radical prostatectomy
- Laparoscopic radical prostatectomy using high-tech complex "Da Vinci"
Take a closer look.
This is one of the first methods that was adopted. Removal of the prostate gland is through an incision either in the lower abdomen (radical retropubic prostatectomy) or between the anus and scrotum (perineal).
How is manipulation
The operation of proctectomy involves a cut length of about 10 cm in the abdomen, after it is removed from the iron. If there are indications for removal of lymph nodes, this type of manipulation allows you to do it. Are savedintact nerve fibers responsible for erection and retention of urine. As a result, the urethra is sewn directly into the bladder, so the first time installed a catheter, which is removed after restore the function of urination. Rehabilitation after the intervention takes about a week.
The second option is less frequently used because the operation does not allow the removal of lymph nodes, in addition, significantly increases the risk to damage the nerve fibers responsible for erection. A small incision is made in the perineum, removal of the prostate gland occurs in the back. However, recovery after prostatectomy less long.
Advantages and disadvantages
Today, this technique gives way to a more effective and painless, in comparison with which the disadvantages of open surgery are many:
- high risk of complications (impotence, abnormal voiding, stricture of the urethra);
- long recovery period;
- pain interference;
- significant blood loss (in comparison to the laparoscopy).
The benefits can be attributed, perhaps, only greater accessibility and a sufficient number of qualified specialists in our country.
Laparoscopic radical prostatectomy
Relates to minimally invasive and involves the use of instrument – the laparoscope. Today laparoscopic prostatectomy is the most gentle form of intervention, it allows to reduce time of stay of the patient in the hospital.
The course of the operation
Through small incisions in the abdomen, the laparoscope is introduced, equipped with a video camera, and surgical instruments, which separates the prostate from adipose tissue, ligaments, and surrounding organs, then removing it. The postoperative period is about 5 days, depending on the condition of the patient.
The pros and cons of the method
The advantages of the method include:
- the reduced risk of complications compared to open surgery;
- good tolerance by patients;
- a short recovery period;
- the quick recovery;
- low blood loss.
However, the surgeon's hands can not be compared in accuracy with the movements of the "hand" of the robot, so when warned of such consequences prostatectomy as impotence, incontinence, recurrence of disease, endoscopic laparoscopy is significantly inferior to the robotic.
Laparoscopic radical prostatectomy using high-tech complex "Da Vinci"
The first robot-assistant "Da Vinci" was designed by American specialists. After a successful year 2002 operationsremoval of prostate cancer this method is formally "kicked off", he began to develop doctors around the world.
Robot "Da Vinci" is the eyes and hands of the surgeon. An assistant allows the doctor to detail to see the operating field due to the appearance on the screen three-dimensional magnified image, fully control the operation and to accurately produce all manipulations because of the greater freedom of movement of instruments and a filter to suppress tremor of the human hand
On the surgery
The operation involves the execution of several small punctures, which are placed in the tools "hands" of the robot. They are visualization of the process and the separation of the affected prostate. If necessary, clean and lymph nodes. One of the most difficult tasks for prostatectomy – not to damage the nerves responsible for erection (located on the sides of the prostate), and muscles involved in the mechanism of continence. At this stage, every move, every move is extremely important. How exactly will be done this phase of work will occur if such effects as impotence and urinary incontinence.
Prostate removed, the bladder connects to the urethra with anastomosis.
In the first days after the intervention with the participation of the robot "Da Vinci", the patient is allowed to get up. This is a very important advantage, if the patient has a propensity for thrombosis. Early activity reduces the risk of blood clots. Possible meal (a moderate amount).
Advantages and disadvantages
Of course, this method has many advantages:
- minimal blood loss;
- fewer complications due to high-precision performance;
- excellent tolerability by the patients;
- higher chance of maintaining erections and normal urination;
- a short postoperative period
- the quick recovery.
The disadvantages include the cost. In the course are expensive equipment, components, involved surgeons of the highest qualification.
The effects of the conduct. Biochemical recurrence
The main danger and insidiousness of the cancer is a relapse (return of illness). The main positive effects that can be achieve complete freedom from prostate cancer, when a recurrence is eliminated. According to statistics, 30 to 40 % of cases after removal of the prostate gland, the disease returns,"gives back". However, about 75% of patients undergoing prostatectomy, happy with the result and quality of life.
An indication that a recurrence appeared, is the level of PSA (prostate-specific antigen) in the blood. Immediately after prostatectomy, it is usually equal to zero, and this is the norm. If thenthe figure of the DOG begins to grow, so there is a biochemical recurrence and cancer is not over (in the body left tissue producing PSA). For when occurs and increases as the PSA level can be the judge of what kind of recurrence (local or systemic). To resolve biochemical recurrence, using a variety of methods: observation, hormonal therapy, radiation or a combination of both.
Like most surgeries, the radical prostatectomy can cause negative consequences. Their presence or absence is largely determined by the skill and experience of the operating surgeon controlling the progress of the operation. The most common is:
- violation of potency (50 to 90% of cases);
- urinary incontinence after radical prostatectomy (3-36 %);
- stricture urethral channel (5-17 %)
Rarely, complications such as thrombosis of the veins of the legs (occurs in people with a tendency to thrombosis), inflammatory diseases, dysfunction of the bowel.
In order to come to final recovery, after the surgery you should carefully monitor their health, comply with the instructions of the doctor. Here are a few simple rules:
- to continue the antibiotics if they have been assigned, with the purpose of prophylaxis of infectious complications;
- to use more fluid (prevents urethral stricture);
- not to lift weights, limit physical activity, to walk more;
- regularly visit the doctor, to inform him of warning signs, if they appear;
- constantly check the level of PSA in the blood in order to eliminate recurrence;
- diet to avoid constipation;
- return to sexual activity after consulting a doctor;
- to perform a Kegel exercise to strengthen pelvic floor muscles.
In conclusion, I would like to note that prostate cancer is not a reason to give up. Modern technology, new diagnostic techniques allow us to achieve impressive results: to extend the life 10-15 years and minimize the risk that there will be a relapse. I hope the information provided was useful for You. Be healthy!