Details about prostatectomy: types, features of the recovery period and possible consequences

Prostatectomy is a type of surgical procedure in which a complete removal of the prostate gland is performed. The indications for surgery are malignant prostate tumor, and benign tumors( adenomas) of large dimensions with the ineffectiveness of other treatments.

Types of operations and procedure for

Prostatectomy is divided, depending on the methodOperative access, to open and laparoscopic. To the open are the retropubic( periorbital) and perineal. In practice, the retropubic is performed more often.

Radical prostatectomy involves not only complete removal of the prostate, as well as passing inside the prostate urethra, the seminal vesicle, lymph nodes and neurovascular bundles. The purpose of this operation depends on the individual characteristics of the disease and is performed by any of the following accesses. Radical prostatectomy

When retropubic prostatectomy surgical incision is carried out along the median line of the abdomen below the navel in the direction B pelvic region provide access to the prostate pubic bone length of 12 cm., Which together with the seminal vesicles was separated from the bladder and removed from the body. The resulting tissue is examined( histologically, under laboratory conditions), the result is about a week later.

Nerve-vascular bundles pass close to the prostate gland, and can be affected by a pathological process. With a large prevalence of the tumor and its malignant nature, it is not possible to preserve these formations( and erectile function).This aspect is advisable to discuss before surgery with a surgeon to clarify the probability of weakening or loss of potency after prostatectomy.

Radical removal of the prostate gland.

The final step of the operation is to connect the urethra with the bladder, install a drainage tube in the area of ​​the removed organs, and also conduct the catheter through the urethra into the bladder.

The posterior prostatectomy allows for removal of pelvic lymph nodes, intraoperative( during operation) diagnosis for the presence of tumor cells, which makes it possible to clarify the prevalence of the process and increase the efficiency of the operation.

retropubic prostatectomy has the greatest duration( up to 4 hours), and a crotch laparoscopic - about 2-3 hours.

In perineal prostatectomy, an incision is made between the anus and the scrotum. This type of operation has the disadvantage of a lack of access to the pelvic lymph nodes, the removal of which involves radical prostatectomy. Perineal is the method of choice in persons with significant excess weight. Laparoscopic surgery

3-6 make incisions( 1-1.5 cm) In laparoscopic surgery, where the optical system is placed. The optical system allows you to illuminate the operating field, fix it on the camera and transfer the image to the monitor. Also in places of the cut, special tools are placed, with the help of which prostate removal is performed.

Laparoscopic prostate surgery.

Currently, the so-called robot-assisted prostatectomy is also performed laparoscopically. Its difference lies in the fact that in the course of surgical intervention, the use of precision robotic manipulators is used by the doctor. Contraindications to operation

Large volume of surgery and remote tissues, the need for general anesthesia, duration up to 4 hours determine a number of limitations and features in preparation.

Basic contraindications:

• age over 70;
• decompensation and severe cardiovascular disease;
• planned administration of medications that affect the blood clotting system( fractiparin, heparin, aspirin, warfarin, syncumar, clopidogrel).

Operative intervention is possible not earlier than a week after the abolition of drugs that slow blood clotting.

Consequences and complications of

It is necessary to distinguish complications associated with a disease, for which a prostatectomy is performed, and the consequences of the operation itself.

Violation of urination is the most common complication after prostatectomy.

Surgery may be complicated:

• by violation of urination( more often - by urinary incontinence);
• by narrowing the urethral lumen due to trauma( stricture);
• a violation of potency;
• by thrombosis;
• a violation of the intestine.

Features of the recovery period

The recovery period lasts an average of 1.5-2 months.

Its duration depends on:

• severity of the disease;
• volume of surgery( removal of only the prostate or lymphatic and blood vessels, neural bundles);
• age;
• of the patient's general health.

The early postoperative period and hospital stay varies from one to three weeks. When laparoscopic surgery, as a rule, 7-10 days.

You can drink water 3-4 hours after the patient has woken up and recovered from anesthesia. The doctor allows the doctor to take meals, in the absence of complications, one day after the operation.

Recommended as a diet in the early days:

• sour-milk products that do not contain sugar;
• boiled or steamed lean meat( veal, rabbit, turkey);
• lean boiled fish( pike perch);
• eggs.

From the second to the third day, the diet can be expanded with boiled vegetables( beets, carrots) in the form of salads with the addition of vegetable oil, steamed prunes. Such food contributes to the normalization of the intestine. After the first independent emptying( in most cases - in 2-3 days), you can gradually and carefully switch to the usual diet, excluding irritating spices( vinegar, pepper), as well as smoked and salted.

After prostatectomy, drains of the postoperative zone are removed for 4-5 days, the sutures are removed after 1-2 weeks. Established during surgery, the urinary catheter is longer in the bladder, it is daily treated and removed after 2-3 weeks.

After operation, you can not lift weights.

To prevent vascular thrombotic complications and stagnant phenomena in the lungs, as directed by a doctor, it is recommended to get up, starting from 2-3 days after the operation. In the future, gradually expand the motor regime. Physical stress is not recommended until complete recovery( up to 2 months).

In the early period it is very important to hold the place of the postoperative suture with the help of a pillow in case of sudden movements( sneezing, coughing, laughing).In the future, for the safety of seams and the prevention of the development of postoperative hernias, special bandages are used, which must be worn before lying down and other minor physical activity. Constant wearing is not recommended, as this will weaken the muscular framework.

To reduce discomfort in the seam area, it is recommended:

• wear loose trousers or tracksuit;
• use a round-shaped litter with a filler( gel or foam) to reduce pressure in the perineum when sitting;
• comfortable armchair.

After 10 days after the operation, it is necessary to gradually expand the motor activity: take walks in the fresh air, increasing their time from 15 to 45 minutes. Return to the driving machine can be 3 weeks after the operation. To the usual morning exercises and the resumption of sexual activity( with the preservation of the erectile function during the operation) can be started 2 months after the operation.

Possibility of convalescence and relapse of the disease

Recovery or complete cure is likely with early diagnosis of malignant tumors, as well as with timely intervention in benign. After prostatectomy, the survival rate for five years reaches 100%, the 10-year survival rate ranges from 60 to 95%, depending on the type and extent of the tumor process, as well as the complete removal of all tumor cells. It should be borne in mind that in most malignant tumors only treatment of the prostate gland is not limited to treatment. Other types of treatment are used: radiation, chemical methods.

Prostate-specific antigen( PSA) is a marker of oncological processes and sharply increases in malignant neoplasms of the prostate. The first time the examination of this indicator in a patient who has undergone a prostatectomy is carried out 3 months after the operation.

When detecting a PSA level greater than 0.2 ng / ml, there are fears of recurrence of the disease.

Further dynamic monitoring of PSA level:

• in the first year after surgery - 3-4 times a year;
• in the second year - 2 times a year;
• further - one study per year.

The level of PSA after prostatectomy should not exceed 0.2 ng / ml. If its growth is observed, this indicates a relapse or metastatic cells producing PSA.Since the detection in the blood of an increased amount of this antigen is significantly ahead of the confirmation of the presence of malignant cells by instrumental( ultrasound, CT, MRI) methods, this condition is called a biochemical relapse.

When establishing a diagnosis of recurrence of prostate cancer, conservative methods are used to treat it.

The most effective are:

• remote irradiation of the bed of the removed tumor;
• treatment with high intensity focused ultrasound( HIFU), which allows to focus on areas deep in the body;
• hormone therapy, including in combination with chemotherapy.

At a late( no earlier than 2 years later) biochemical recurrence and a slow increase in the PSA level( more than 10 months) are limited to monitoring and monitoring the general condition of the body and possible changes in the pelvic area.

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