Prostate cancer: surgery to remove the prostate
- How to prepare for the surgery?
- Performing anesthesia for getting rid of prostate cancer
- Radical prostatectomy procedures
- Perineal prostatectomy
- Prostatectomy nerve-sparing
- Immediately after surgery
Surgery to remove the canceron the prostate gland - treatment of prostate cancer with the state by its removal.This type of treatment is possible in a situation where the cancer has not gone beyond the boundaries of the prostate (stage T1 or T2).There are also exceptional cases where the procedure of removal of a tumor of the prostate cancer is carried out in the range of greater spread.
When prostate cancer surgeon main type of intervention - radical prostatectomy.Her operate openly or by laparoscopy.Below we consider the open method of carrying out an operation to remove the male prostate.
operation involves complete removal of the prostate in conjunction with the tissue surrounding it, which in
In addition to this type of surgical treatment of the prostate can also be used following prostatectomy technique:
- laparoscopic minimally invasive;
- nerve-sparing radical.
may be carried out and transurethral resection of the prostate tumor condition.This type of treatment is performed internally to alleviate the disease.
Factors influencing the choice of a particular method of intervention of the surgeon:
- patient's age;
- stage at which the cancer has passed (the dimension and position of the tumor in the tissues);
- extent to which the cancer has (his aggressiveness);
- expressed as symptoms of prostate cancer;
- state of the male body in general, identified additional disease.
Next, consider how to conduct preoperative preparation, that is anesthesia and open way of radical prostatectomy.
How to prepare for the surgery?
Preoperative preparation includes several important aspects.
Prior to surgery because of prostate cancer need to pass several tests: the total on the blood and urine, biochemical composition and blood clotting.Usually examination before the operation also includes an x-ray of the chest, holding the ECG.If necessary, designate other analyzes.The result of the overall survey and handed over analyzes provide the basis for physician assessment of the patient readiness for surgery.Analyses take place in clinics for a week or two before the start of the operation.
on prior consultation it is mandatory to inform the doctor about all medications taken (especially those that are blood thinners: warfarin, aspirin), said about the absence or presence of a predisposition to bleeding.For 1-2 weeks should stop taking these medications.
In hospital the patient is hospitalized for 1-2 days before the planned date.
eve necessarily hold a conversation the anesthesiologist and the surgeon.They will explain all the steps that will be taken for anesthesia during the surgery because of prostate cancer.It will be said about the possible consequences and risks of anesthesia and surgery.In the course of conversation, the doctor can find out the issues that particularly concern.At the end of the conversation the patient offer to sign in agreement to carry out operational procedures.
becomes important correctly held bowel preparation for surgery because of prostate cancer.One day before the start of the surgical procedure, doctors recommend eating only in liquid form.Paramedic perform the night before and the morning cleansing enema.
It should also be noted that if you are going to remove the cancer under general anesthesia, the last meal is allowed on the evening of the day that precedes the date of the procedure.On the scheduled day, you can not eat and drink.If the medication provides zapivanie water, it is possible to make small sips.
month before the scheduled date of the removal of prostate cancer a man has to start training to strengthen the pelvic floor muscles.
is calculated on the Kegel exercise.
This exercise has three parts: the compression at a slow pace, cutting, pushing.How to compress: you must first relax the buttocks and the abdomen.Then strain the muscles of the pelvic floor, as if at a stop defecation.It must be a sensation of contraction of the anal opening.This tension must be held for 3-5 seconds.Over time, relax.How to do the exercise on the reduction: tension and relaxation of muscles in the groin area at a rapid pace.How to perform a third group of exercises: to be tighter, as is done during defecation or urination act.
One exercise group performed 5-10 times in one sitting.Replays Kegel exercises during the day should be 3-5 times.With each subsequent week the frequency of exercise particular group increased by 5 repetitions.Exercise starting to make not less than 5 times per day.For beginners it is recommended to exercise the muscles on pins from a prone position.By learning you can train the muscles while sitting or standing.
anesthesia Performing at getting rid of prostate cancer
Radical prostatectomy is performed under general or regional anesthesia.The latter has two varieties:
Each type of anesthesia has its advantages and disadvantages.Most anesthesiologists preferred spinal and epidural anesthesia, as it is associated with a lower incidence of anesthetic complications.Installation of an epidural catheter provides a good effect for postoperative analgesia.
Regional anesthesia techniques involve the fact that men do not mind switched off throughout the intervention process in the body.To prevent psycho-emotional stress, the anesthesiologist has the right to supplement regional anesthesia connecting sedatives.
When you can not use regional anesthesia techniques for prostate cancer surgery is performed under general anesthesia (endotracheal).In this case, during the entire process the patient is unconscious, his breathing is carried out through a special tube with the help of ventilation system.
Performing radical prostatectomy procedures
open radical prostatectomy is performed of the two approaches.And here are distinguished:
- retropubic prostatectomy;
- perineal prostatectomy.
retropubic prostatectomy is performed by making an incision in the lower abdomen.Using a procedure possible to remove the prostate gland of large dimension and regional lymph nodes.
procedure is performed, placing a man on the back or in the so-called lithotomy position (on his back, with his feet set on the stand provided).
After all the necessary measures to handle the anesthesia, the surgeon starts working field operations antiseptics and surrounded by land sterile cloth.Then the doctor makes a midline incision in the abdomen, the length of which is 7.0-9.0 cm.
Thereafter, the dissection of tissue layers in the front wall of the abdomen with the release of the bladder neck, the gland itself, iliac large vessels, which are located along the lymphaticpelvic nodes.
If necessary, before performing prostatectomy can be performed lymphadenectomy (procedure for getting rid of regional lymph nodes).Lymphadenectomy ahead surgery to remove prostate cancer.
Then, the mobilization and resection of the prostate along with the seminal vesicles, located close to it.In the process of getting rid of prostate urination cross the channel, while the prostatic urethra area clean at the same time with the male gland.
When the prostate is removed, the surgeon stitches the part of the urethra, which remained with the neck of the bladder (vesicoureteral imposes anastomosis).At the same time they give birth to a catheter into the bladder.At the end of the hemostasis with drainage of the prostate bed (drainage installation) the wound is sutured in layers.When such an operation blood loss is about 2.0-3.0 liters.
By the time the operation lasts from 2 to 3 hours.
sequence of operations is set out very simplistically.However, the operation aimed to cure prostate cancer - a very complicated procedure in the urology.
crotch (perineal), open prostatectomy - surgical method by which it is possible to remove the prostate through an incision in the perineum area.This type of surgical procedure was tested in 1869, Buechler and was the only technique of surgical treatment of prostate cancer by up to 70 years, it has not yet been developed a method for retropubic prostatectomy.
retropubic access has become popular because it provided an opportunity to remove the lymph nodes.
Nevertheless perineal access has some obvious advantages over RRP: operation lasts much less offer easier access to the prostate, there is less blood loss, post-operative period pain is expressed less recovery period and shorter hospital stay.More preferred perineal access for patients with obesity.
Cons.Unable to remove the lymph nodes of the local, which implies recourse to laparoscopy.In addition, this method does not accurately carry out the work on the nerve fibers, which are located near the prostate and is responsible for potency.Therefore, it is not possible to carry out by prostatectomy nerve savings.
access operations through the perineum is unacceptable to perform in a situation of serious pelvic joints arthritis, ankylosis, the presence of an artificial prosthesis, because of these reasons make it difficult to laying the patient in the desired position on the operating table.
At large sizes perform prostatectomy prostate crotch difficult.In this situation, the operation is performed by retropubic or prescribe hormone therapy prior to the procedure designed to reduce the prostate in size.
Open perineal prostatectomy performed at lithotomy position on top.The patient in this case is laid on his back and his legs are bent at the knees and placed in the provided stand - stirrups.
Having laid the patient, the surgeon performs the processing of field operations iodine or alcohol-based antiseptic.
zone then draped with sterile cloth.The doctor makes an incision in the shape of the letter U in the area of the perineum (between the anus and the scrotum).
After the tissue layers are dissected, and the male gland with seminal vesicles are visualized, the surgeon will remove them.Prostate removed simultaneously with prostatic urethral zone, located therein.Then the rest of the urinary channel is connected to the bladder neck, joining them.Administered in bladder capacity catheter.The incision was sutured in layers.
Duration of treatment - 2 hours or 2 hours and 30 minutes.
operation for carcinoma of the prostate is carried out in order to prevent post-operative consequences.Erectile function is controlled by two bundles of nerves that are located along the prostate.The surgeon during nerve-sparing prostatectomy tries to avoid damage to the integrity of these beams.However, in every case it is possible to remove the prostate without hitting the nerves.Then the risk of a violation of erectile function, much higher.
Conducting nerve-sparing treatments for prostate cancer is associated with the risk that a number of tumor cells remain in the area saved nerves.The ability of nerve sparing technique therefore estimated during the procedure.The surgeon makes a visual assessment of vascular involvement of nerve fibers in the cancer process.Therefore, if there is, then, in spite of a request to maintain the patient's erectile functionality, the surgeon removes the affected blood vessels and nerves.This technique justifies the fact that the result of cancer is seen as a priority.erectile function can be restored by applying the prosthesis in the future.
nerve-sparing Prostatectomy is shown to those who have early prostate cancer, when the tumor is still small and does not leave the boundaries of the male prostate gland.Implementation of nerve-sparing techniques is not possible if the tumor process is located in close proximity to nerves or rooted in their cells.
Immediately after surgery
On the operated patient movable bed transported to the intensive care unit.Postoperative devote a few hours the doctor monitoring the early postoperative state (recovery of consciousness, respiratory function, heart rhythm, and pressure).