Details about TUR of the prostate, training, rules of conduct and consequences
Transurethral resection of the prostate (TUR of the prostate) is a minimally invasive surgical procedure that involves partial or complete removal of the overgrown prostate tissue by exposing it to electrical current. Method is considered the "gold standard" in the treatment of benign prostatic hyperplasia.
How is it performed
Transurethral resection involves the use of a special instrument – resectoscope. The device is a thin metal tube and is inserted through the urethra.
Its main parts are:
- the optical system allows the surgeon to carry out a visual inspection);
- electrodes (loop with different bending angle) that directly impact on the fabric when removing it or evaporating the cauterizing blood vessels;
- trunks (thin-walled tube with a locking connection, through which there is flow of the solution and its extraction that allows you to rinse the area of operation and provide the necessary visibility).
So, the resectoscope is introduced into the cavity of the urethra, then with the help of optical instruments, the prostate is visualized. Further, under the control of the fabric is "cut" and was evacuated with a special pump. When manipulation is carried out, the removed tissue remains, which are in the form of "chips" floating in the cavity of the bladder. If necessary, additional stops bleeding after resection.
In conclusion, a test is carried out a site inspection of the operation and only after that, the resectoscope is removed. Transurethral resection of the prostate is performed under General or regional anesthesia and usually takes less than an hour, because the frequency of complications depends on the duration of surgery. After her bladder was drained with a Foley catheter. The catheter is removed 3-4 day, and at 5-7 days, in case of absence during this period, any complications, patient is discharged from hospital for outpatient treatment.
It should be noted that transurethral resection of the prostate is one of the most complex operations in the field of transurethral endo-surgery, requiring precision, with exceptional knowledge of endoscopic anatomy, as well as extensive practical experience of carrying out similar manipulations.
The benefits of intervention
Transurethral resection of the prostate refers to the more modern, minimally invasive methods of surgical intervention. In comparison with traditional adenomectomy, which consists in excision of the prostate, transurethral resection ‒ the less traumatic manipulation. It is characterized by a better tolerability, a lower percentage of complications and not soa long period of recovery after surgical vmeshatelstva.
According to the European Association of urology, transurethral resection of the prostate currently is about 95% of all operations performed in patients with BPH. In addition, adenomectomy is often the cause of erectile dysfunction, and after TUR of the prostate risks are significantly reduced, which is especially important for young patients.
Today to replace transurethral resection come more gentle and effective methods of treatment, such as removal of the adenoma by exposure to laser beam (in particular, the enucleation of the prostate using the holmium laser). However, this method is not widely used because of its high cost and the small number of specialists who have mastered this technique.
Indications and contraindications
The first step is to enumerate situations in which surgical intervention is not enough (medication does not give the desired effect, after which the quality of life is rapidly deteriorating):
- Acute or chronic urinary retention, indicating obstruction of the bladder.
- The occurrence of acute pain and heaviness in the lower abdomen, unbearable painful urination.
- The development of infectious inflammatory diseases on the background of hyperplasia of the gland.
- The development of the pathology of other organs, associated with BPH, particularly renal failure arising from disorders of urine outflow.
- Blood in the urine (hematuria).
Transurethral resection of the prostate is primarily used when:
- the size of the adenoma up to 80 cm3;
- the relatively young age of the patient when it is important to retain potency;
- the inability to hold adenomektomii.
However there are some contraindications to the use of the method. Among them:
- Narrowing and deformity of the urethra, preventing the introduction of the resectoscope.
- Varicose veins of the bladder neck.
- The size of the adenoma of more than 150 ml.
- Infectious diseases of the genitourinary system, especially in the acute phase (prostatitis, urethritis, epididymitis, etc.).
As with any manipulation, a contraindication is a critical condition, blood disorders involving clotting disorders, use of anticoagulants or antiplatelet agents (acetylsalicylic acid, warfarin, etc.).
Complications and risks
Some complications occur in the early period after the operation is bleeding, syndrome of water intoxication (TURP syndrome), damage to the urinary tract, acute urinary retention, infectious-inflammatory complications.
Some complications make themselvesto know more in late postoperative period: bladder neck sclerosis, urinary incontinence, relapse, retrograde ejaculation. Over time, there may come a restoration of disordered functions.
Overall, the percentage of those who after the operation the TOUR had problems is relatively small ‒ 15-30 %, while the efficiency reaches 70-90 %.
Undoubtedly, in each case, the justification for surgical intervention can only be assessed by a doctor. If the decision operation has been made, the next step is preparing for surgery.
Preparation and postoperative period
Before surgery, transurethral resection of the prostate in the first place surrender all the necessary tests, consultation with the anesthesiologist and surgeon. The patient should stop taking medications that affect blood clotting (anticoagulants) to reduce the risk of bleeding. Before transurethral operations mandatory antibiotic prophylaxis. Initially prescribe a broad-spectrum antibiotic, after the drug replaced by a more narrow spectrum. On the eve of the carried out cleaning of the intestine, and on the day of surgery, you need to refrain from eating and drinking.
After discharge from the hospital, you will undergo a period of rehabilitation. Body needs recovery. In order to avoid complications, it is necessary to strictly carry out doctor's instructions:
- to continue the course of treatment with antibacterial drugs;
- regularly visit the doctor;
- not to overwork himself loads and heavy lifting;
- diet (not eating spicy, fried, greasy);
- to lead a healthy lifestyle (no alcohol, no Smoking);
- to refrain from sexual activity in the first months after surgery;
- to drink more water.
Of course, there is the risk of complications after the application of the method of transurethral resection of the prostate, but at the same time, it may be an excellent chance to return to normal life, life without pain!