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
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
HOW TO COPE WITH EARLY BPH. LIVING WITH BPH. Early Stages of an Enlarged Prostate.
July 7, 2009 | Leave a Comment
HOW TO COPE
WITH EARLY BPH
Living with the early stages of an enlarged prostate isn’t all that hard:
This is true. Remember, you had BPH for eight to ten years before it caused you any problems at all. You might have had some mild symptoms for another two or three years before you realized it and found out what was causing them. Now you know.
Now is no time to panic. So these problems caused by BPH area small inconvenience, they are something you can learn to live with. The alternative is not a happy thought.
Let’s go back to our typical case history. This gentleman is the one who is sixty years old and has the three most minor of BPH symptoms: a brief hesitancy when urinating, a slower, less forceful stream, and he usually gets up once a night to urinate.
The secret here is that you know what the cause is of these minor problems, which means you can learn to manage them. You have managed a lot of things in your life, right? First the other kids in your family, then a wife, then your own kids, then that business and all the people you had under you. Compared to that, managing early BPH is a breeze.
First the worry. The experts say again and again that BPH is not cancer, has no connection with prostate cancer, does not lead to cancer and is an entirely separate ailment. So get that out of your mind.
You don’t have prostate cancer, it’s only BPH.
Urologists fight this misconception all the time and gradually they’re winning. They point out that cancer of the prostate is almost always on the outside of the prostate lobes. The enlarged prostate grows inward and outward. There is absolutely no casual relationship between the two.
Now, one more concern with prostate cancer. When surgery is needed for BPH, usually at a much later time than in a man’s fifties or early sixties, there is a finding that about ten percent of the BPH prostates will be found to have a cancer.
Remember, cancer can strike any part of the body at any time in life. It has no connection to BPH. When these cancers are found they are not in the usual places where they could be easily diagnosed during your regular BPH exams. So in reality the BPH surgery is a stroke of luck since most of these cancers are just beginning and are caught quickly so they can be eradicated more easily.
So, from here on we don’t worry about BPH causing or being tied in with prostate cancer in any way. Clear?
LIVING WITH BPH
Urologists point out that the minor symptoms of BPH, often the initial ones, may be the only troubles a man suffers with BPH for as much as ten to fifteen years. That means you shouldn’t even be thinking about or concerned with any worry about prostate surgery or other treatment now. Dump it right out of your computer memory hard disc. Why worry about something that isn’t going to happen for ten to fifteen years? You’ll have plenty of time to fret and stew about it and discuss it with your urologist when the time comes. By then some even better treatments undoubtedly will be developed.
Concentrate on today, and how to make your life pleasant and interesting and fulfilling, right now! in spite of BPH.
We know that there is no “cure” for BPH. You can’t take a pill and like a headache your BPH will just go away. It isn’t that kind of a problem. Even with our miracle modern medical cures, there is nothing even on the drawing boards that will magically cure BPH. So we practice positive thinking and forget about that and move on to areas of behavior that we can and should do something about.
Plain old fashioned horse-sense. With the decline of the horse as the basic transportation unit of Americans, not much is heard anymore about horse-sense. Too bad. Horse sense has shaken down to “common sense”, which is almost as good.
For example, it makes no sense to drink two gallons of water a day when you know you’re going to have to urinate most of that water the same day. Don’t overload your urinary system. The less you drink the less you’ll have to urinate.
Don’t carry this to extremes. The body is at least 1,259 percent water. You need water, fluids, to survive. But there is a happy medium. Some doctors say a man should drink eight, eight ounce glasses of water a day. That’s half a gallon. Actually what they mean is that the body should intake that much fluid a day: coffee, water, milk, soup, colas, juice, any fluid should count.
Many other doctors say this is much more fluid than the average man needs. Your body will tell you when it wants a drink. As a common sense living-with-BPH, start cutting down on your fluids a little at a time. You’ll be urinating less, but still enough. Talk to your urologist or doctor about this and find out what the minimum daily need is for intake fluids for a man of your size and activity. It may be much less than you suspect.
If you do manual labor in the hot sun all day, you’ll need more water than if you’re in an air-conditioned office where you work on a computer. Your doctor will be able to help you here.
TIME YOUR FLUID INTAKE
If nocturia bothers you, and you’re getting up three times a night to urinate, try limiting your fluid intake in the evening. One doctor suggested not to drink any fluids for four hours before retiring. That way your body will have processed your fluids, and passed them well before your sleeping time.
Using a modified system such as this (some men have one small drink at dinner and nothing after that) many BPH patients can cut to once their nocturnal urination. Now that is a real blessing if you can go from three risings to only one a night. This is a prime example of how you can manage your own life to reduce the interference of BPH with your normal activities.
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.
Jul
7
LIES, MYTHS AND OLD WIVES TALES ABOUT PROSTATITIS
This is a good time to start debunking some of the wild stories and myths and gossip that usually makes the rounds about the lowly prostate. Here are a list of the top ten. You may have heard of some more:
1. Prostate surgery always causes a man to become impotent.
This is simply not true. In the past it was more true than it is today, but now there are newer techniques used in surgery that do not disturb the nerve bundles that run on either side of the prostate. These nerves control a man’s ability to have an erection and intercourse. In cancer surgery, doctors have learned to remove the prostate usually without damaging these nerve bundles. However, some patients still suffer impotency. In the BPH surgery, only five percent of patients suffer any impotency.
2. An enlarged prostate, BPH, is a leading cause of prostate cancer.
Absolutely not. The enlargement of the prostate is in no way connected to the development of prostatic cancer. The cause of the enlargement is not known, but the cause of cancer is and the two are not linked. This myth may have come about because during some surgeries for the relief of BPH, the prostate is found to be cancerous when it had not been so diagnosed before. This actually can be one of the hidden benefits of such surgery.
3. Prostate surgery automatically sterilizes you.
In one half to two-thirds of the patients who have prostatic surgery where some or all of the prostate is removed, the normal course of the semen and other fluids usually ejaculated is disrupted. The fluid takes the course of least resistance and flows upward into the bladder instead of down the urethra and out the penis. To a man 60 or 65 this is usually not so important. However if children are wanted, the semen can be captured from urination soon after the orgasm and used for artificial insemination.
4. Prostate problems turn a man into a wimp.
If this happens it isn’t the result of the prostate problems. There is no loss of manhood, physical or psychological from any of the prostatic problems. There may be psychological side effects by various individuals, but these are mental in nature and could be casued by any number of reasons.
5. Prostate disorders are embarrassing to talk about because they mean a man is oversexed and having sex far too often.
A pure fantasy. Prostate problems and their treatments should not be embarrasing to talk about. Indeed a woman should realize an intelligent and understanding attitude toward prostate testing and evaluation, could save her husband’s life.
6. Orgasm for the man after prostate surgery isn’t the same, isn’t satisfying.
Simply not true. In case after case, the men report that the feeling at the time of orgasm and ejaculation is unchanged from what it was before surgery. Whether the ejaculation fluids go back into the bladder or out the penis, the feeling is exactly the same for the man. If there is a change, it is psychological and unfounded.
7. “Damn, man. Your sex life is over after BPH surgery.
Again, not factual. Any man’s sex life changes as he gets older. In his sixties and seventies a man has sex less frequently than when he was twenty. For at least ninety-five percent, a man’s sex life will be the same after BPH surgery as it was before. For the other five percent, there will be some problems with impotency—but that can be dealt with.
8. Incontinence is an automatic result of BPH surgery.
Researchers show us that only four percent of all BPH surgeries will result in the patients having trouble retaining their urine. That’s twenty-five to one odds, not bad.
9. There are lots of over the counter remedies that will cure my prostate without surgery.
By the end of 1990, the FDA took all such advertised remedies off the market. Previously the Postal Inspectors had closed down dozens of mail order houses who sold them. We will talk about the compounds in these products. Many people believe they are effective in reducing symptoms of BPH. Most do not say they can cure prostatic problems.
10. Prostate is a dirty word and a gentleman never mentions it in mixed company.
Ridiculous. In this more enlightened age, when women are encourged to examine their breasts for lumps, men must be encouraged and badgered into having at least yearly prostate examinations. The best way to do this is through education, and talking about the problem. Talking to the wives of the target men is often the most effective method.
Now, let’s move on to an in depth look at the ailment that affects nearly all older men, BPH.