Jul
19
RETROPUBIC PROSTATECTOMY w5tbpqac7u
In this surgery the same type incision is made as in the suprapubic operation. The muscle is separated and the sac containing the intestines is moved away from the bladder.
Now the surgeon makes an incision into the prostate capsule and removes the enlarged gland. The tissue removed is tested by a pathologist to determine if there is any cancerous growths present.
Now the surgeon sutures or cauterizes the bleeding vessels and the catheter with the three way tube is placed into the bladder. This catheter is usually the same type as used in a TURP operation. Next the balloon is inflated to keep the catheter in place.
All that is left is for the surgeon to “close”. The prostate capsule is sutured shut and the muscles, fascia and skin are put back in place and stitched closed.
This operation differs from the previous one since the bladder itself was not opened. It’s slightly simpler with less violation of the body. This means there is no need for the second catheter through the belly to drain the bladder.
The draining and irrigation of the prostate needed can be done with the usual three-way catheter. Most urologists say that this operation is less stressful to the patient since the bladder is not cut open, so it doesn’t have to recover.
General recovery procedures and time is about the same for either type of operation. Which type your urologist might suggest would be determined by the individual patient’s condition and sometimes the doctor’s preference.
In surgery for the prostate, the general rule is that a medium sized enlarged prostate and smaller ones can be successfully removed by the TURP method. However when the gland swells in size to over fifty to sixty grams, the urologist will usually do one of the other operations because of the difficulty in scraping out that much tissue and drawing it out of the urethra.
In these cases the larger prostate removal by the retropubic or suprapubic is simply the most efficient method to be used for the well being of the patient.
OTHER TYPES OF PROSTATE SURGERY
Perinea) prostatectomy is another kind of open surgery for the prostate but it is seldom used today. This procedure is quick and simple to do, but almost always severs the nerve bundles that control erection and leaves the patient Impotent.
Doctors back in the 1930’s often used a two stage operation for the prostate. The first stage was opening and draining the bladder. Then two weeks later they would go in and remove the prostate. It is seldom used today.
With the new treatments now coming into focus for the prostate, particularly BPH, there may be a general slowing in the number of surgeries needed. Any surgery has risks but with the prostate the risks seem to be reasonable in regards to impotence and incontinence, the two problems most men fear the most.
With the development of the new drugs, we may see products that will cause the enlarged prostate to shrink without objectionable side effects. With the increased use of the balloon as at least a temporary treatment for BPH, and other inventive methods, some experts are predicting that the use of surgery will not be required as often in future years as it is today. Only time will tell. As the public learns more about the male prostate and BPH, more men will demand non-intrusive treatments whenever possible. Right now a lot of men are hanging their hopes on the new drugs Hytrin and Proscar.
Jul
17
DANGERS AND SIDE EFFECTS
Let’s take a closer look at TURP and the statistical dangers and side effects.
1. Retrograde Ejaculation. This is in effect defacto sterilization. There is no other way to describe it. A vital part of the reproductive system in the male is contained in the prostate and other elements are injected into and flow through the urethra situated inside the prostate.
When most or all of the prostate is removed, the fluid that the prostate produces to lubricate and carry the sperm down the urethra is also gone. Now when orgasm takes place, muscular contractions propel the spermatozoa and fluid from the prostate and seminal vesicles into the prostatic urethra.
At the same time this happens, the neck of the bladder closes so the fluids must go down the urethra and out the penis. But after TURP surgery, this bladder neck closure is usually cut away to provide more space for the urine flow.
With the bladder neck open, the sperm and the fluid take the path of least resistance and are propelled into the bladder instead of out the penis.
This is called retrograde ejaculation. The sensation of the orgasm is the same for the man, there just isn’t any outside ejaculation.
With many TURP patients this is not a problem. Most men in the good TURP surgery candidate pool are no longer interested in fathering children. In most of the cases when a patient is told about this drawback and result of the TURP, he will not have any major problems with it. The trouble comes when a patient is not told about retrograde ejaculation and finds out on his own and is furious that he wasn’t informed before the operation.
In the extreme case where fatherhood is still desired, the ejaculate can be retrieved after the next urination after the orgasm, and the semen gathered and preserved and used in an insertion procedure into the woman’s vagina, the same as any artificial insemination. It works.
2. Bleeding. TURP involves a lot of cutting of tissue and the enclosed blood vessels. Bleeding is a natural course of events. Most of the bleeding is stopped during the operation by cauterization.
As with any cut or wound, a scab develops. This should stay for two or three weeks and then fall off. By then the blood vessel should be healed. If the scab falls off sooner bleeding usually begins and shows up in the urine.
This happens in only about one percent of all TURP patients and is often caused by straining to pass a stool. Usually this bleeding can be helped by a patient drinking lots of fluids to cleanse the area. Only rarely is there a need for the patient to be readmitted to the hospital to correct the condition.
3.1ncontinence. (The inability to control voiding of urine.) This is one of the big fears of a TURP surgical patient. It is embarrassing and distressing, and can lead a patient to total social isolation.
Incontinence happens to from one to four percent of all TURP patients. Many urologists claim it is less frequent, and say it can be the result of the normal surgical risk factor.
The problem comes when the electric knife cuts too near the sphincter voluntary muscles which control the flow of urine. If these muscles are damaged then the patient may become incontinent.
The other means of continence is the external urethral sphincter. Damage here can lead to a stress type of incontinence.
Incontinence after a TURP operation does not have to be permanent or irreversible. There are drugs that can be used to relieve the situation. Another possibility here is the use of an artificial sphincter.
At any rate this is one of the areas that you should discuss with your doctor prior to any prostate operation.
4. Impotency. Experts in this field say about five percent of all TURP patients come out of the operation and are impotent even though they were not that way going in.
Impotency is simply a man’s inability to achieve an erection, or to maintain it long enough for vaginal penetration.
The “manliness” of a male is a highly subjective area, and statistics on this element may be dramatically wrong in either direction. Many men may say they are able to achieve an erection and have intercourse when they are 70, 75, even 80. But age and other problems may have reduced that libido drastically so that even they were not totally cognizant of their ability to achieve a working erection. Time and age does this to all men.
Sometimes such an operation is a handy whipping boy for the sudden realization of impotency.
In any case, impotency is a fact of life for some of the men who have TURP operations, and you should know about it now. There is one sure way to develop impotency in a TURP patient. That is to damage one or both of the nerve bundles that are on each side of the prostate. These bundles are outside of the true capsule of the prostate. That means they are well outside of the area a surgeon’s electric knife should be operating to remove the prostatic tissue clogging the urethra. This is to say that a TURP properly carried out, should not harm these nerve bundles and that should not be the reasons for any impotency.
Some psychologists say that sex is at least 75% mental. This is why the cause of impotency, especially in men from 60 to 90 is extremely difficult to tie down. It may have been there before the operation and not recognized. The operation might create a psychological block preventing the erection. A now and then lack of a man’s ability to “get it up” is not uncommon even in younger men. The trauma of the operation, even the thought of some danger to a patient’s “manhood” and a negative spousal situation all can combine to create a psychosomatic impotency. This may be of a short or long duration.
There are drugs that can be used to help this impotency, and several devices that will be covered in a later chapter. Impotency, while not a large factor, is one that the surgery candidate for TURP should be well aware of.