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
18
THE SUPRAPUBIC PROSTATECTOMY.
July 18, 2009 | Leave a Comment
THE SUPRAPUBIC PROSTATECTOMY
In this surgery an incision is made below the navel and to a point just above the pubis. An alternative may be an incision just above the pubic hair. The incisions will be from four to six inches long.
The surgeon goes in here cutting through skin and its lining. The patient’s muscles covering the bladder are carefully separated and the sac covering the abdominal wall is pulled back. Then an incision is made in the bladder.
Now the surgeon removes the prostate gland and the tissue is examined for any evidence of cancer. Cauterization or sutures close off all bleeding vessels. The stitches will dissolve later.
When bleeding is controlled, the surgeon inserts a catheter in the penis and up through the urethra into the bladder to irrigate it. The bladder is then emptied.
Now a second catheter is inserted directly into the bladder. It will leave the body just below the navel. This catheter is used to drain urine and irrigation fluids from the bladder after the operation. It is larger than the one in the penis and more effective.
Continuous irrigation of the bladder and the prostate area is continued for two days. The large catheter is removed in a day or two but the penile catheter is left in for six or seven days. This allows urine to be removed from the bladder and lets the prostate area heal.
After the catheter is removed the patient usually can urinate normally.
Jul
16
TRADITIONAL PROSTATE SURGERY.
July 16, 2009 | Leave a Comment
The electrical wire loop emerges from the end of the tube and is used to cut away the prostatic tissue. Power is applied to the electric loop by the use of a foot switch when the surgeon wants to cut.
As he does this, the surgeon is watching the procedure through a lens that is located just outside the end of the penis.
When bleeding occurs inside the urethra, another foot pedal is pressed and the bleeding part is sealed off by cauterization so it won’t bleed. During the surgery the entire area is washed by glycine.
After the surgeon decides that he has removed enough of the enlarged prostate, the chips and shavings of the prostate tissue are removed with the glycine wash and sent to a pathologist who studies them to see if there are any beginnings of cancer of the prostate.
The surgeon may elect to remove most or all of the prostate but he will not harm the prostate’s surgical capsule. This new hole that has been created through the overgrown prostate now becomes a urinary canal. This means that the prostate enlargement tissue was growing around the urethra gradually closing it down and narrowing it. The inner walls of the urethra have been cut away carving a new canal through the prostatic tissue growth.
After the cutting is done, a thin, flexible rubber or plastic tube is then passed through the penis and urethra and into the bladder so urine can be drawn from the bladder.
This tube remains in place for a few days because of some bleeding that may take place in the prostate. When the tube is removed, the patient will be able to urinate normally again.
This catheter, used after the TURP surgery, consists of three lumens or tubes. One is used to send in and remove a wash of saline solution, salt water, into the bladder to irrigate and clean it. This saline solution usually is used for twenty-four hours after surgery.
The second tube is used to draw off urine. The third usually has a small balloon attached and is inflated so the catheter will not fall out.
The catheter to draw urine from the bladder stays in place for two days after surgery.
Most patients feel good enough to get out of bed a day after surgery and are feeling much better after four days. Yes, you can walk and talk and sit down with the catheter in place. It usually comes out on the second day and no pain is involved.
The surgeon will deflate the balloon and the catheter can then simply slide out. The following day, most patients are discharged and sent home. Hospital stay: two days.
Most TURP patients get a prescription for antibiotics to be taken by mouth for one to two weeks after the surgery. This is a precaution to ward off any infection.
Post surgical suggestions from his urologists will probably advise the patient to take hot baths rather than showers for a while, drink lots of fluids, avoid spicy foods and watch out not to become constipated.
There won’t be any touch football games for a while, but most of the patient’s activities can be resumed, including driving, sitting at a desk and taking walks.
If there is any trouble it probably will be a slight burning during the first two weeks when he urinates, and even small amounts of blood in his urine. If this happens, the patient should call his urologist and report the problem just to be on the safe side.
When can you get back to work’? These are general guidelines. You’ll follow your doctor’s orders here. They will depend on the doctor, the patient and how well he recovers. Generally: If you do heavy manual labor, best to wait four to six weeks. Moderate labor will call for three to four weeks of vacation. The mental giant behind a desk or in a white collar position can get back in his harness after two weeks.
One caution. The TURP patient should hold off any sexual activity for six weeks after surgery. This will allow the canal through the prostate to heal completely.
The TURP surgery is performed about 400,000 times a year in the U.S. and the numbers probably are rising with the increase in percentage of our male population reaching the BPH age.
PROSTATE SURGERY
When you and your urologist decide that the best way to handle your BPH or other prostrate trouble is surgery, you have another decision to make. Which type of surgery will do the job that needs to be done?
Today, about 95 % of all BPH surgery uses the standard transurethral resection of the prostate, or TURP, as it is called.
Your urologist will explain to you in detail what this surgery involves.
The TURP is what surgeons call a closed operation. That simply means that there is no incision made in the body to get at the problem.
The TURP uses a surgical instrument that is inserted into the penis through the urethra. He’ll point out to you that this is done after the use of anesthesia. The instrument is a nonflexible hollow tube that extends into the narrowed portion of the urethra inside the prostate.
Inside this tube the urologist will insert a fiber optic micro-lens system that doctors call a resectoscope. This device includes a fiber optics light source, a lens and a electric wire element for surgery. The light inside the urethra lets the doctor see the problem and determine the severity of the problem.
Jul
7
PROSTATE PROBLEMS AND ALCOHOL, BEER AND COFFEINE.
July 7, 2009 | Leave a Comment
ALCOHOL AND BEER
You knew this was coming. Alcohol is not good for the human body. Alcohol is especially not good for men with BPH.
“Hell, give up beer and a few shots of bourbon and maybe a highball or two? Damn, I’d rather die!” Such typical comments by moderate and heavy drinkers is often answered with the assurance of: “You will die and probably sooner than you expected to.”
For years some urologists have said that alcohol irritates the prostate. It also can cause serious problems with the liver. Some of the flavorings in alcohol can affect the prostate to such a degree that it can cause a kind of chronic prostatitis
For a man with even early BPH, the sudden or overuse of alcohol can bring on a surprise attack of acute retention of urine. This condition results in a desperate need to urinate but it is impossible. A quick trip to a doctor’s office or the emergency room of a hospital for catheterization and draining the bladder follows.
Good old common sense dictates that a man with even early BPH should seriously consider his consumption of alcohol and its relation to his prostatic condition. At this point many men simply don’t want to take the risk or stand the pain and problems associated with alcohol and BPH and stop drinking.
Beer drinkers will be furious, but the pint-in, pint-out and the much used bathrooms at bars and taverns, indicate that it is well known that beer drinking is immediately followed by voluminous urination.
Here common sense leaps up again. Beer drinking in the afternoon may be easily tolerated by some men, but not by others. Late night beer drinking will almost surely trigger two or three additional night time trips to the bathroom that otherwise could have been avoided.
If you insist on drinking beer, use a little common sense so it doesn’t trigger more unpleasant BPH reactions.
COFFEE, COLAS AND CAFFEINE
Yes, caffeine is the big tiger on your back here. Caffeine is a stimulant to the urinary tract: it makes you urinate more and more frequently. For most well people this is no problem, not even a minor inconvenience. Over the years your body will adapt to the added caffeine.
But when you have BPH, it’s different. You don’t need any more stimulation in your urinary tract. Neither do you need any more volume.
The BPH coffee drinker who normally goes through twelve, eight ounce cups of coffee a day is going to have a much harder time living with his urinary tract, than the non-coffee drinker, or even the man who drinks twelve, eight ounces of non-caffeine fluids a day.
Ounce for ounce, coffee and tea contain twice the amount of caffeine that regular cola drinks do. Of course now most of the colas come in caffeine free types as well. This is one place where you can have your cola and not your caffeine.
In the same manner, there are many caffeine free coffee brands now on the market.
If you want to manage your body with a little more “smarts” give the caffeine free drinks a test in your own bathroom. You’ll probably be pleasantly surprised when you make the test.
Oh, the “Principle of the single differential”. When you make any of these intake tests, try to do everything else the same, except for the item you’re testing. If you have two differentials (variables) in your life style, you won’t be able to tell which one made the difference, if there is a difference. It’s an old principle from the physical sciences but it works.
If you drink caffeine fluids, take the test. Try the caffeine free types for a week, doing nothing else different. One BPH patient said it cut his nocturia risings down from two a night to one. After a few weeks you’ll even forget what the caffeine laced drink tasted like.
Don’t forget that many of the current pain pills for headaches, colds and hay fever also contain caffeine. While these aren’t taken often, you might look for some that don’t have caffeine in them, such as the ibuprofen medications.
Jul
7
ACUTE URINE RETENTION. BHP.
July 7, 2009 | Leave a Comment
ACUTE URINE RETENTION
In this busy, busy world of ours, many men are working so hard and going so fast that they don’t take time for regular physical checkups. Some never think about prostate problems until it’s almost too late.
Again the symptoms of BPH can slip up on a busy man. He simply figures that by sixty-three he should be urinating more often and he’s heard other men talk about needing to get up at night once or twice. He thinks nothing of it.
Then one day he needs to urinate but can’t. He stands there waiting and then straining but he can’t pass even a few drops and he’s hurting like crazy. Soon the pain is so agonizing that he calls his doctor or rushes down to a hospital emergency room to find out what’s the matter.
A catheter drains the urine from the distended bladder and relieves the problem. Some patients with acute urine retention might be holding as much as a quart of urine. Most patients will look much better within minutes and feel fine in an hour or so.
A sudden attack of acute urine retention can happen to almost any man who has some obstruction already in his urethra. There are also conditions that can bring on such attacks.
Prolonged exposure to the cold, especially if you are not used to it can sometimes bring on such an attack. Drinking alcohol by someone not used to it. The sudden use of antihistamines is also a culprit in this case.
Such an attack is usually enough for the patient to have his prostate checked critically by an urologist who will advise him if any treatment or surgery is needed — as well as suggestions about how to prevent such an attack in the future.
So, there is your primer on BPH, its symptoms and some details about the problems it brings up. Now, is there a way to live with these problems during that time when the doctor recommends no major treatment is needed. We’ll look at that in the next chapter.
Jul
7
WHAT PROBLEMS CAN EXTREME PROSTATE
ENLARGEMENT CAUSE?
Silent Prostatism. Sometimes the prostate will enlarge and there are none of the usual symptoms. The urethra continues to close but somehow the man simply doesn’t realize the problem or decides that he’s just getting old and the “water works” sometimes doesn’t work right for him.
If this condition builds and builds, more and more urine can be left in the bladder that can’t be expelled in urination. This can result in a serious problem. The patient will become excessively tired and feel weak, he will be irritable and could suddenly collapse or even lapse into a coma.
When large amounts of urine are left in the bladder and it isn’t strong enough to expel the liquid through a narrowing urethra, serious damage can occur. This can lead to a serious backflow pressure of the urine on the kidneys. At the most serious, such a problem can cause kidney failure and a quick death.
In cases like this the patient needs to get to a hospital quickly so a catheter can be used to drain the bladder. With the emptying of the bladder, the patient will feel much better almost at once. Then the doctors will watch to see if any permanent damage was done to the kidneys and if so what additional treatment might be needed.
Depending on the seriousness of the situation, the patient’s normal kidney function should come back after a week to three months. At that time the prostate should be checked for size to see if prostate surgery or some other treatment is required.
CONGESTION OF THE PROSTATE
Sometimes after normal BPH symptoms in a patient, an urologist will find only a moderately enlarged prostate but one that is mildly congested. There often is no sign of infection. Typically there might be a minor amount of urine that can’t be drained from the bladder during urination.
Often there will be some form of obstruction at the bladder outlet which also restricts bladder emptying.
At this point there is no major problem for the patient and he would be put on a maintenance program to have his prostate checked regularly.
As the prostate grows and the bladder muscles are forced to work harder and harder to push the urine through the narrowing urethra, the bladder can become fatigued. In some cases the bladder will simply quit functioning and urine buildup occurs in the bladder.
This can form a place where bacteria can grow and multiply rapidly. When this happens the patient feels a burning pain when he urinates. Sometimes the urine will have a bad odor and traces of blood can show in the urine.
A danger here is urinary infection, which is usually signalled in the patient by a burning sensation when urinating, chills or fever and the intensification of his regular BPH symptoms.
Here, as in other early symptoms of BPH, the patient may go for several years without any more serious problems than his minor BPH problems.
On the other hand the congestion may increase, and if this happens the patient’s urologist may suggest a prostate massage. Here the prostate is massaged digitally through the rectum and the congested fluid is expelled. This makes the heaviness vanish and a more normal life returns.
The urologist may suggest that a patient have regular prostate massages to relieve the congestion. Or it may be relieved by regular ejaculations through intercourse or masturbation.
Some urologists never recommend repeated prostatic massages. But all suggest in situations like this that the patient should avoid long periods of exposure to intense cold weather, should avoid most spicy foods, should sharply reduce the use of alcoholic beverages, should avoid antihistamines, and they recommend the patient to take warm baths often.
Any shift or intensifying or change in symptoms of the BPH should be reported to the patient’s physician or urologist at once.