Other Surgical Procedures For Prostate Disease
Alternative surgical procedures to TURP include:
- open enucleative prostatectomy this involves making a cut in the abdomen to remove a very enlarged prostate. This is the least common form of surgery. The average hospital stay is seven to 10 days
- laser TURP a laser is used to remove prostate tissue from the middle part of the prostate, which has the advantage of less bleeding and therefore safer for people on anti-coagulation therapy for other problems, including coronary stents, heart valve or vascular disease
- transurethral incision of the prostate similar to TURP except that no prostate tissue is taken out. One to three cuts are made in the prostate near the bladder neck to release the ‘ring’ of enlarged tissue and make a larger opening around the urinary tract
- UroLift® this technique is useful for men for whom medication has not been successful but their prostates are not so enlarged that they need a TURP. It involves the transurethral insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.
How Is Bph Diagnosed
After evaluating your medical history and giving you a complete physical, your doctor will perform a digital rectal examination.
Because the prostate gland is in front of the rectum, the doctor can feel if the back of the gland has any abnormalities during this examination. This enables the doctor to estimate the size of the prostate and to detect any hard areas that could be cancer.
Several studies may be done to help diagnose your condition:
Why Would You Have Your Prostate Removed
Surgery for partial or complete removal of the prostate is called a prostatectomy. The most common causes for prostate surgery are prostate cancer and an enlarged prostate, or benign prostatic hyperplasia . Pretreatment education is the first step to making a decisions about your treatment.
Which is better TURP or laser?
There was no difference between the two procedures in terms of hospital stay or complications. However, men in the TURP group achieved a faster urinary flow rate . TURP was also slightly more cost-effective and faster to perform than the laser procedure.
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Histopathological Analysis Of The Specimens
All prostate specimens were processed in accordance with a well-established protocol and reviewed by a pathologist . The pathologist recorded the tumor location, extracapsular extension , seminal vesicle invasion , vas invasion, pathological Gleason score, pathological stage, and positive surgical margin. A positive surgical margin was defined as a cancer gland reaching the inked margin.
Prostate Growth And Sex
Urinary problems caused by BPH are known as lower urinary tract symptoms, or LUTS. Men with LUTS often have problems in the bedroom.
The link between LUTS and sexual problems is not fully understood. But many of these men have a lowered sex drive, trouble maintaining an erection, and theyâre less satisfied with sex. Depression, loss of sleep due to frequent nighttime trips to the toilet, or some related physical cause may play a role.
Whatever the reason, the worse LUTS get, the more trouble a man may have in the bedroom. LUTS can be treated, so see a doctor early, before the symptoms cause a bladder problem or begin to spoil your sex life.
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Benign Enlarged Prostate: What Are The Pros And Cons Of Surgery
Surgery can very effectively reduce the problems associated with a benign enlarged prostate. It is considered if other treatments dont provide enough relief, or if the enlarged prostate keeps causing medical problems such as urinary tract infections. But surgery often has side effects.
Most men who have a benign enlarged prostate arent in urgent need of surgery. They can take their time to carefully consider the pros and cons. There are various possible reasons for deciding to have surgery. For instance:
- The prostate-related problems may be very distressing, and other treatments may not have led to a big enough improvement.
- The enlarged prostate may frequently cause other medical problems, such as recurring urinary tract infections or bladder stones.
- Treatment with medication may not be possible for medical reasons.
What Other Problems Might An Enlarged Prostate Cause
A small number of men may find it difficult to empty their bladder properly this is called urine retention. If youve been diagnosed with an enlarged prostate, your doctor will look at your test results to see if youre at risk of urine retention. You may be more likely to get urine retention if:
- youre aged 70 or over
- your prostate is very large
- you have a raised prostate specific antigen level
- you have severe urinary symptoms and a very slow flow.
Chronic urine retention
This is where you cant empty your bladder fully, but can still urinate a little. It usually develops slowly over time. Chronic means long-lasting. The first signs often include a weak flow when you urinate, or leaking urine at night. You may feel that your abdomen is swollen, or that youre not emptying your bladder fully.
Chronic urine retention is usually painless. But the pressure of the urine can slowly stretch your bladder muscle and make it weaker. This can cause urine to be left behind in the bladder when you urinate. If you dont empty your bladder fully, you might get a urine infection, need to urinate more often, leak urine at night, or get painful bladder stones. You might also see some blood in your urine. Chronic urine retention can damage your bladder and kidneys if it isnt treated.
There are treatments for chronic urine retention, including:
- passing a thin, flexible tube called a catheter to drain urine from your bladder
- surgery to widen the urethra.
Acute urine retention
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Relationship Between Measured And Estimated Prostate Volumes
The estimated volume from TRUS imaging assumes an ellipsoid geometrical shape of the prostate using the formula . In order to identify the best coefficient for this series of 153 fresh prostate specimens, we used the measured prostate weight converted to measured prostate volume by using 1.02g/cc as the density, as defined above. Thus, the mean measured volume of our cohort was 48.1cc .
Measured prostate volumes along with TRUS-obtained prostate dimensions were then used to calculate a new coefficient from the rearranged algebraic formula: Coefficient=V/L x H x W, where L, H and W were all obtained by TRUS, and V is the measured prostatic volume of fresh prostates, obtained just after surgery, as mentioned above. This calculation was performed for each of the 153 prostates, which led to a calculated mean coefficient of 0.66.
Linear regression plots were created in order to compare the newfound coefficient of 0.66 with the ellipsoid coefficient of 0.52. Figure a shows that plotting estimated prostate volumes against measured prostate volumes using 0.66 as a coefficient yielded an equation of y=0.892x+8.8829 with an R2 value of 0.42 . By performing the same analysis using 0.52 as the coefficient, the equation generated was y=0.5652x+13.028 with R2=0.32 .
Fig. 1Fig. 2Fig. 3
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Minimally Invasive Procedures For Bph
Minimally invasive surgical therapies for BPH, such as free-beam laser therapy, radiofrequency ablation, transurethral needle ablation, prostatic urethral stents , and alcohol injection, are relatively simple procedures that can usually be performed in an outpatient setting, often with decreased postoperative catheterization time.
For patients at very high medical risk who cannot safely undergo significant anesthesia or surgery, these minimally invasive treatments may offer some benefit. Prostatic urethral stents, for example, have been suggested as a reasonable BPH treatment alternative when medical therapy has failed and the medical risks of surgery are unacceptably high. Stent migration, dysuria, and pain are relatively common complications but are easily reversible with stent removal.
These minimally invasive methods do not allow tissue to be saved for pathological analysis and do not remove the entire adenomatous prostate thus, retreatment and even TURP is sometimes required later. Up to 25% of patients who receive these minimally invasive treatment alternatives ultimately undergo a TURP within 2 years.
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How Many Grams Is An Enlarged Prostate
The mean weight of the normal prostate in adult males is about 11 grams, usually ranging between 7 and 16 grams. The volume of the prostate can be estimated by the formula 0.52 ×length× width ×height. A volume of over 30 cm3 is regarded as prostatomegaly .
Secondly, how do you reduce the size of an enlarged prostate? To help control the symptoms of an enlarged prostate, try to:
Also to know is, what is enlarged prostate size?
Enlarged prostate. The prostate gland surrounds the urethra, the tube through which urine passes out of the body. An enlarged prostate means the gland has grown bigger. Prostate enlargement happens to almost all men as they get older. An enlarged prostate is often called benign prostatic hyperplasia .
At what size of prostate requires surgery?
For patients with prostate glands larger than 80 grams, an open prostatectomy is performed. After the surgeon makes an incision from the navel to the pubic bone, the bladder is opened and tissue of the prostate is removed.
The Different Types Of Prostate Surgery
The term prostatectomy is used to describe a number of different surgical procedures to remove either part or all of the prostate gland. This may be required to treat prostate cancer or BPH.
When only a part of the prostate is removed, this is called a simple prostatectomy. This process involves enucleating it from its capsule to trim away excess tissue, but where the sphincter muscle and nerves remain intact. It is usually used to treat BPH, which is a benign condition, meaning there is no risk of malignant cells having moved on to surrounding tissue.
When the entire prostate gland, capsule , the surrounding lymph nodes and neighbouring tissue is removed, this is known as a radical prostatectomy. This is usually a treatment for men with localised prostate cancer and there a number of techniques used:
Open Surgery This is where the prostate is removed via a large single incision in the lower abdomen, or the perineum .
Laparoscopic Radical Prostatectomy This is where the prostate is removed via several small incisions in the lower abdomen using small surgical instruments. This process is much less invasive than open surgery.
Robotic-assisted radical prostatectomy Much like laparoscopic radical prostatectomy, the prostate is removed via small incisions in the lower abdomen. Robotic-assisted instruments are inserted through the incisions and controlled by a surgeon.
Holmium Laser Enucleation of the Prostate
Transurethral Resection of the Prostate
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Why The Procedure Is Performed
An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your doctor may tell you changes you can make in how you eat or drink. You may also try some medicines.
Your doctor may recommend prostate removal if you:
- Cannot completely empty your bladder
- Have repeat urinary tract infections
- Have bleeding from your prostate
- Have bladder stones with your enlarged prostate
- Urinate very slowly
- Took medicines and they did not help your symptoms
Do I Need Surgery For My Enlarged Prostate
Answered by: Dr Rajesh Ahlawat | ChairmanDivision of Urology and Renal TransplantationMedanta Kidney and Urology InstituteMedanta, the Medicity
Q: I have an enlarged prostate. The ultrasound report says: Right kidney measures 120 X 49 mm and Left kidney measures 109 X 46 mm. Both kidneys appear normal in echo texture and size and there is no hydronephosis or calculi. Corticomedullary differentiation is maintained. Urinary bladder appears normal. No evidence of any mass or calculus seen. Prostrate is enlarged in size, median lobe is projecting into base of bladder. Size-51 x 47 x 45. Weight-60.9 gms.Post void residual urine: 72 cc. No evidence of free fluid is seen. IMPRESSION: Prostatomegaly grade II.About three years back the report was almost the same except that post-void residual urine was 60 cc and the prostate weight was 36 gms. I am taking BP medication for the last several years and am currently on Prazosin tab 1mg in the morning and 1mg at night . I have problem of polyurination which is controlled with the medicines but sometimes even with medicine the problem occurs. Do I need to go in for operation for removal of enlarged prostate? If yes, the old open surgery or the current laparoscopy would be better? If I don’t go in for operation what is the worst which can happen to me?
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Surgical Alternatives To Turp
Surgical alternatives to TURP are designed to decrease blood loss, inpatient hospitalization, and fluid absorption, while still removing or destroying the obstructing prostatic tissue. These include transurethral vaporization of the prostate , bipolar TURP, photoselective vaporization of the prostate , and holmium laser enucleation.
Reports comparing these various prostatic ablative techniques by Van Melick et al, Eaton and Francis, and Gilling et al show that they all demonstrate improvement that is roughly equivalent to TURP in terms of urodynamics, symptom scores, and uroflowmetry parameters for at least 7 years.
Noble and colleagues compared these techniques in a randomized, controlled trial from a strictly economic point of view. They concluded that noncontact laser therapies tended to be the most costly surgical treatment option, while TURP was the most cost-effective.
Electrovaporization of prostate
Electrovaporization of the prostate uses a ridged or pitted cylindrical metal roller electrode instead of the standard wire loop. This roller electrode conducts the electrical cutting current at very high energy levels, resulting in complete vaporization of the prostatic tissue it contacts. This method results in relatively good hemostasis with less bleeding and fluid absorption than the standard TURP.
Holmium enucleation of prostate
Prostate Surgery With Urology Specialist
Dr Arianayagam is highly experienced in all aspects of prostate surgery, in particular robotic radical prostatectomy.
Dr Arianayagam performs robotic radical prostatectomy at both Macquarie University Hospital and Nepean Public Hospital. Dr Arianayagam has performed over 250 robotic cases. He is a proctor for Device Technologies, who supply the Da Vinci Robotic System in Australia. Being a proctor means Dr Arianayagam is qualified to teach other surgeons to use this technique.
If you have any questions regarding prostate surgery, or would like to book an appointment, please feel free to contact Urology Specialist here.
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At What Size Of Prostate Requires Surgery
TURP developed itself to become the gold standard of surgical treatment for medium sized prostates. The EAU guidelines, based on grade A evidence, recommends TURP for prostates between 35 and 80 ml. Over that limit, open surgery seems to remain the only option for treating BPH, according to available clinical evidence.
Which Is Better Turp Or Laser
Laser surgery. Laser procedures usually give you symptom relief and better urinary flow similar to TURP . However, some laser therapies produce fewer side effects than others and also reduce the risk of bleeding. Long-term studies are needed to find out whether laser treatments are as effective as TURP .
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What If A Screening Test Shows An Elevated Psa Level
If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs at regular intervals to watch for any changes over time.
If a mans PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a transrectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum . A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
Why Would You Have Surgery For A Benign Prostate Condition
The prostate is the walnut-sized gland that surrounds the urethra in a male. The urethra is the tube that carries urine from the bladder to outside the body. One of the non-cancerous conditions that can affect the prostate is called benign prostatic hyperplasia , which is also known as enlarged prostate.
BPH is the most common prostate problem in men over age 50. About half of men in their 50s and as many as 90% of men in their 70s and 80s have enlarged prostates.
Enlarged prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:
- An inability to urinate.
- Excessive blood in the urine.
- Bladder stones.
Prostate cancer and infertility arent symptoms or causes of BPH. Benign prostatic hyperplasia doesnt cause erectile problems.
Prostate procedures for BPH range from minimally invasive treatments to more extensive surgeries. Your healthcare provider will help you decide which type of prostate surgery is best for you.
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Surgery May Be Required To Treat A Range Of Conditions That Affect The Prostate Here We Take A Look At The Three Most Common Types Of Prostate Surgery
In the case of cancer, these procedures are performed to stop the spread of malignant cells. For BPH, surgery may be required to relieve symptoms that are making it difficult to urinate, which can have a significant impact on quality of life.