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
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.