Friday, 23 December 2016

Surgical Procedures to treat Enlarged Prostate or Prostate Cancer

Non cancerous enlargement of prostate gland (BPH- Benign Prostate Hyperplasia) may lead to urinary symptoms which can ease with certain lifestyle adaptations or in other cases with medicines. However, depending upon the severity of the symptoms and in-cases where lifestyle modification and medicine do not give sufficient relief, surgery may be recommended.

Other less common procedures which might be available in private healthcare or in clinical trials.

These are
  • Photoselective Vaporisation of the Prostate 
  • Minimally Invasive Surgery, such as Transurethral Needle Ablation or Transurethral Microwave  Therapy 
  • Transurethral Vaporisation Resection of the Prostate. 


This is a fairly common procedure which removes the overgrown parts of prostate that press on the tube (urethra) through which urine passes out. Depending upon the aesthetic administered you may be awake (spinal anaesthetic) or asleep (general anaesthetic) during the surgery. The surgeon passes a thin tube into the urethra through your penis. The tube ending has a miniature camera so that the surgeon can see the prostate clearly. The second step involves removing tiny pieces of prostate tissue by passing an electrically-heated wire loop through the tube. Fluid is passed into the bladder to withdraw small pieces of prostate tissue that have been removed. After the surgery these removed pieces may be analysed to check for any abnormal cells. A catheter is used to remove urine from the bladder till two days after the surgery following which the nurse removes the catheter and checks if you are passing urine successfully.

Advantages:

Following the surgery one can urinate with greater ease
Effective in long run
Bladder stones if present can also be removed

Disadvantages:

The improvement in symptoms is not immediate rather it takes several weeks
In certain cases, a person maybe unable to pass urine once the catheter has been removed. If this happen a new catheter is put in place for a few more days.


This procedure is similar to TURP except instead of using electrically heated wire loop HoLEP uses high-powered laser to remove the parts of prostate tissue that press upon the urethra blocking urine flow. Prostate tissue which is removed during the procedure passes into the bladder and is removed using a different instrument. HoLEP requires specialist equipment and only a trained surgeon can carry out this procedure. Therefore, it may not be available everywhere. During surgery a person may be awake up unable to feel anything (spinal anaesthetic) or maybe asleep (general anaesthetic).  After surgery, a catheter is used to drain urine from the bladder for the next 12-24 hours. Before you are discharged, the nurse removes the catheter and checks if you are able to pass urine easily. Research studies have shown that HoLEP and TURP are equally effective in improving symptoms.

Advantages

Effective in case of men with very large prostate
More suitable than TURP in men who are on anti-coagulants (medicines that prevent blood clot)
Suitable also in treating bladder stones

Disadvantages

The treatment is relatively new and not easily available everywhere.
In case of a small percentage of men find they cannot pass urine at all after the catheter has been removed. In such cases a new catheter is put in place for a few more days



Similar to TURP but here parts of prostate tissue are burnt away by heating the prostate tissue rather than removing it. After the surgery a person is on the catheter to drain the urine for the next 9-24 hours. Depending on the anaesthetic administer you might be asleep (general anaesthetic) or awake (spinal anaesthetic )but unable feel anything during the surgery.

Disadvantage

The only disadvantage is that the tissue gets destroyed and cannot be sent for further lab examination. 
9-10 per cent men might feel that they are not able to pass urine after the surgery and may need to be on the catheter for a few more days. However, chances of this are seemingly higher in case of TURP.


Bladder neck incision is also called Transurethral Incision of the Prostate (TUIP). A doctor or a nurse may recommend this procedure in situations where a person has a small prostate and is still experiencing urinary symptoms. Although this is similar to TURP it has a shorter recovery time. Either a general or spinal anaesthetic is used. A thin tube is passed into the urethra through the penis  following which an instrument is passed which is used to make one or two small cuts in the neck of the bladder or prostate gland so that the bladder neck widens and urine can flow easily.

Advantages

Catheter is removed sooner than in case of TURP.

Disadvantages

In a small percentage of men are not able to pass urine once their catheter is removed. In such cases a new catheter is put in place for a few more days.

There is not much information about the long term effectiveness of this procedure.

The prostate tissue is not removed. Therefore cannot be analysed.


This procedure removes the inner part of the prostate gland through a cut in the stomach area. A general anaesthesia is administered during the procedure. The time a person spends in the hospital depends on the case, recovery and doctors advice. However, usually it takes up to four to six days although several months may be taken to fully recover.

Advantage

The tissue can be sent for further examination.
The treatment is as effective as HoLEP in men with very large prostate.

Other treatments

Photosensitive Vaporisation The prostate tissue with vaporised by a high energy laser. The recovery with this procedure is faster with a shorter hospital stay in comparison to TURP.
Minimally Invasive Surgery The procedures are carried out with tiny incision instead of one large incision leading to faster recovery time. 



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