Actualizado: 19 de jul de 2019
1. Make sure the surgeon who's operating on you is the same person explaining the procedure, benefits and possible complications. He is the expert and will lead you through whole process.
2. Inform yourself wether your having Resection (gold standard surgery), enucleation (preferred treatment for big prostates or patients on blood thinners), or vaporization (surgery for smaller prostates and patients on blood thinners).
3. Ask your physician about his conflict of interests about the equipment he is planning on using in your case, meaning that he should choose the right tool for the job, in other words; if I own a steel factory, I could say that steel is the best material for everything, even when this might not be entirely true.
4. Ask your doctor every question you have about side effects, complications and benefits, so you both are on the same channel, there are lots of stories and myths that are not entirely true or realistic.
If after all those visits to your doctor, and after trying all those "natural" remedies, you keep going frequently to the bathroom, you persist waking up at night to empty the bladder, you find yourself spending enough time at the restaurant bathroom that you can read every sing on it, and from time to time you have a little "burning" sensation while urinating that "goes away by itself", among other symptoms (Lower Urinary Tract Symptoms or LUTS), you finally have decided going for that prostate surgery that will remove this annoying symptoms, here you will find some useful information to help you decide what kind of treatment suits you best, among the multiple techniques and devices that seems more related to a Sci-fi than to an Operating Room.
The Prostate is an organ sitting just below the bladder, which only purpose is to produce liquid and proteins to protect the sperm so fecundation and in turn a pregnancy can happen, but after that time that you are looking for having kids, it will only grow larger and in some cases (up to 60% of men age 50 or older) will produce Obstructive symptoms or can be even affected by cancer.
When the prostate continues its growth, it can occlude the bladder outlet, leading to obstruction which puts you at risk of having frequent urinary tract infections (UTI), bladder stones and kidney injury, up to 70% of patients do well with medication only but 30% of men affected with prostatic enlargement will need a surgical procedure to treat the problem and avoid further complications.
Among all different procedures, we can divide them between endoscopic and open, the latter being reserved for those cases in which prostate is way too big or there is also stones in the bladder or the facility lack resources for performing endoscopic procedures, thus we will focus our attention to endoscopic surgery in which a small camera lens is introduced through the urethra to get to the prostate.
We then divide endoscopic procedures by the technique employed and by the type of energy used.
About the technique we divide it in Resection, enucleation and vaporization, and for this purposes we can make use of different energy sources such as monopolar, bipolar, Holmium Laser and GreenLight Laser, which to simplify things use different approaches to generate heat thus destroying or removing prostate tissue and produce coagulation fo the vessels in order to diminish bleeding. Almost all kind of energy can be use for the different types of techniques, except GreenLight which cannot be used to resect although it can be used also to enucleate.
Resection, means for practical purposes to cut the prostate in little pieces, called chips, in order to remove the whole adenoma (benign enlargement of the prostate) and promoting bladder emptying, this little chips are also taken to the pathologist to rule out cancer in this sample. The main disadvantage lies in that we have to cut chip by chip the whole obstructing part of the prostate and this sometimes can be a time consuming job, however this remains the Gold Standard for treating patients with prostates no larger than 80 grams (about 2.8 ounces), because it has the best Cost/benefit ratio of all the surgeries here mentioned.
It can be done with either monopolar (Gold Standard), bipolar, Holmium Laser or even Thulium laser, this last one much less used.
In the other hand Enucleation, is a better procedure for patients with larger prostates (bigger than 80 grams), because time-wise is not that efficient when compared against resection for prostates smaller than 80 grams, but once we pass that weight limit it will be more efficient than resection alone. Technique and devices have improved greatly in the last few years so it is becoming feasible in smaller prostates, although cost of procedure has not changed and it is still far more expensive than resection.
About the benefits of this procedure can be just as good and even superior to the resection results, we can perform this surgery with either monopolar (infrequent), bipolar (increseangly frequent), Holmium Laser (energy of choice and it can be used in patients using blood thinners), GreenLight (infrequent)
Vaporization of the prostate, is a technique in which high temperatures hence high energy is required, with either laser or electric energy, to transform prostatic tissue into vapor, thus diminishing the size of the prostate, this kind of procedure is meant for patients under treatment with blood thinners and/or small size of the prostate.
Due to the use of high energy/high temperature, postoperative discomfort with irritative symptoms (burning sensation while urinating, increased frequency and ugency) can persist for up to six months. As a disadvantage of this surgery there is no tissue sample to analyze, although infrequent in this prostatic zone (less than 10% of prostate cancer cases are originated in this area) it is of high value to rule out cancer in this area.
Recently GreenLight energy has improved and some studies show a SIMILAR (and not superior) results when compared to Resection (TURP) which remains the Gold Standard. Also some other studies have shown less irritative symptoms with improved technology (2nd generation GreenLight) concluding that this side effects must be related with the duration of the procedure (time of exposure to high temperatures).
I know this might be a lot of information to digest, but here are some bullet points to clarify frequent misinformation.
1. Effects on Erectile function are related to the previous condition of the patient's erectile function and none of this procedures have shown to improve erectile capacity.
2. Retrograde ejaculation or anejaculation (inability to expel semen when having an orgasm) it's a risk in ALL of this surgeries, if you want to be sure of not having this side effect, my suggestion is to look for different alternatives such as UROLIFT, that will solve the symptoms and have much lesser probabilities of causing "lack of ejaculation"
3. It is of great importance that your physician offers you all of the alternatives, or at least mention it, and should explain advantages and dissadvantages of each, and if possible the reason why you are being offered a particular procedure.
4. Pain is minimal in ALL of the procedures, regarding the technique or energy employed, and all of this procedures are considered Minimal Invasive Techniques.
5. Medical technology is improving in a fast pace, but sometimes benefit from this advances will apply to a small portion of patients, thus you have to make sure you are being selected to the proper technique because you need it and will benefit from it, and not from following a trend or a hype. Remember there are not "miracle treatments" in medicine.
I Hope this log helps you in your planning and decision making, if you have doubts feel free to ask, remember this is a informative text, and it will not replace your doctor's advice.
At Urocabo clinica, we practice all of this procedures and you can contact me for inquiries.
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