SurgeryBenign Prostatic Hyperplasia

Benign Prostatic Hyperplasia Surgery

Surgical treatment is proposed when symptoms have progressed despite treatment with drugs, when the quality of life is affected, when there is a high risk of complications, or when we encounter one of the following:

  • Bladder stone formation.
  • Incomplete bladder voiding and bladder deterioration.
  • Impaired kidney function.
  • Need for catheterisation due to urine retention.
  • Haematuria or persistent bleeding in the urine.
  • Recurrent urinary tract infections.

The choice of surgical technique depends on the prostate size, the characteristics or biological status of the patient and their preferences.

· Transurethral resection of the prostate (TURP):
It consists of the removal of the prostatic transition area or adenoma by resection and fulguration through the urethra, without any skin incision. It is an endoscopic surgery procedure. It is used in prostate glands between 30-60 cc. It is a very effective treatment. In 65% of the cases, ejaculatory alterations appear.

· Open adenomectomy:
Prostate adenoma removal through open surgery. It is reserved for very large prostates.

Today, a style=”font-size: 16px;” href=”https://rocurologia.com/unidad-cirugia-laser/laser-de-holmium/”>the Holmium laser achieves the same results without the need for external wounds and with more dynamic recoveries, shorter admission time and a very reduced incidence of bleeding. Open adenomectomy is therefore less and less prescribed.

Laparoscopic/robotic adenomectomy:
It is similar to the open adenomectomy, but employs a laparoscopic abdominal approach. Implies abdominal lesions.

 

cirugía hiperplasia benigna de próstata

· Laser adenomectomy:

Another endoscopic procedure which uses laser energy. Different types of lasers are used in the treatment of BPH: green light laser, Holmiun laser and Thulium laser.

Each one is used with a different technique (vaporisation or enucleation) and for different prostate sizes.

All of them yield good results, although we believe that the Holmium laser is the most appropriate one because it is the most versatile, and due to its proven effectiveness, safety and high performance.

· Aquabeam:
New robotic system that removes tissue with a high-pressure water jet.

· Rezum:
New system that, using water vapour, removes prostate tissue and relieves the obstruction produced by the prostate hyperplasia.

There are a number of other non-invasive techniques: Urolift, stents, TUNA, TUMP. They are rarely used and we do not consider them among the standard procedures, except in very exceptional cases or very precise indications.

In general, patients who undergo surgery present good results, with symptom suppression and improvement of their quality of life. The most prevalent or least improved symptom is nocturia or night-time urination, as there are other mechanisms involved.

BPH prostate surgery very rarely affects erectile function or continence. These are instead common complications of prostate surgery due to cancer. Retrograde ejaculation commonly appears. It does not produce any adverse effect on the body, but it may occasionally cause mental discomfort in the patient at the beginning

Two new instrumental methods for the prostate called Aquabeam and Rezum have been incorporated with certain favourable results in the prevention of retrograde ejaculation, and seem to decrease the incidence of such sequelae. The initial results appear to be optimal, although more experience is needed over time to consolidate them. It should not be forgotten that the main objective of prostate surgery in BPH, and in any of its modalities, is to permanently solve the Obstructive Uropathy.

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