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
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.
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.