Radical prostatectomy in the treatment of prostate cancer

Radical prostatectomy for prostate cancer

Among the successful methods of surgical treatment of malignant tumors, attention should be given a radical prostatectomy for prostate cancer. The method is effective in the early stages of cancer, differentiable class T1 and T2 having 7 to Gleason score.

When it is shown, and is contraindicated prostatectomy

Radical treatment of prostate cancer is recommended for stage of disease at 1-2 under pathological changes following conditions:

• Localization - indication for prostatectomy, presence of tumor within the prostate gland, lack of infiltration into the surrounding tissues.
• Analysis of PSA - is not recommended to conduct the operation after the amount of prostate-specific antigen would be above 20 ng / ml. Contraindication conditional. Chemotherapy helps to reduce PSA levels to the required values.
• Degree of cancer and its aggressiveness - the recommendations of the European Association of Urology indicate the possibility of prostatectomy in stage T1 and T2. Provided small aggressiveness and metastasis pronounced, prostate removal is allowed oncology differentiated class T3.
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Contraindications to prostatectomy associated with the individual patient:

• Advanced age.
• Cardiovascular disease.
• Violations that reduce the ability of blood to clot.
• Dangers of anesthesia. General anesthesia poses a threat to the life of patients with vascular disease and heart.

Before determining the feasibility of prostatectomy are appointed by MRI, clinical blood and urine tests, studies on PSA. The choice of course depends on the operation of diagnostic studies, as well as technical capabilities clinics performing the operation.

Embodiments of the radical prostatectomy

While preparing for the selected radical prostatectomy surgery method. When choosing a method of operation take into account the patient's age, possible complications and contraindications. We should also mention endoscopic prostatectomy.

Minimally invasive surgery is performed without any abdominal incisions. The endoscope is inserted through the urethral passage. Surgical resection is performed loop. Pieces of tissue are derived through the endoscope. Radical prostatectomy is carried out in several ways.

The difference lies in the method of administration used surgical instruments and medical equipment.

retropubic prostatectomy

During abdominal surgery used access. For the introduction of surgical instruments and actions incision from the navel to the pubic bone. Currently used three methods of surgical intervention:

• Classical retropubic prostatectomy - performed open access. The prostate gland is removed together with the seminal vesicles. After radical prostatectomy dissected lymph nodes. The disadvantage - high traumatic, caused by damage to nerve endings and subsequent erectile dysfunction.
• Nerve-sparing radical retropubic prostatectomy - method having several advantages. The surgeon is able to provide for measures to preserve the nerve plexus responsible for the activity of the bladder, sphincter and erectile function. Lymph nodes after radical prostatectomy are removed, it is possible to remove the adjacent tissue.
• Vesical prostatectomy - surgery is performed through the bladder. Laparoscopic prostatectomy in this case, traumatic and fraught with serious complications.

In their effectiveness, endoscopic prostatectomy is approximately equal to radical surgery to remove the prostate gland. After opening cavity surgeon can detect metastases in nerve plexuses and neighboring tissues.

In such a case, it requires extended pelvic lymphadenectomy and removal of diseased tissue. It is not always possible to save the patient's erectile function and achieve sustained remission.

But the successful course of the operation, the average life expectancy after the removal of the gland is 10 years, which is essential, given that the average age of patients suffering from prostate cancer 55-65 years old.

perineal prostatectomy

Proceedings operation in this case is associated with preparing access to the prostate via an incision between the sphincter and the scrotum. Perineal prostatectomy includes many drawbacks and negative consequences.

No ability to save plexus, limited access to lymph nodes. After the perineal prostatectomy, there are a number of serious violations of the pelvic organs.

At this point, surgery performed perineal way, almost non-existent.

Radical robot-assisted prostatectomy

For surgery in the field of military action it was developed device, called the da Vinci robot. In fact, it is a manipulator, controlled by a joystick. Advantages of Da Vinci - the cutting accuracy and manipulation, minimizing the damage caused by the human factor.

The disadvantages of robotic prostate removal include:

• Limitations associated with conducting. The equipment is expensive. Robotic units have only the largest clinics located in Israel, Germany.
• The high cost of radical prostatectomy. The operation will cost an average of 35-40 $ 000. About 10-15 $ 000 more than a conventional surgery.

The risk of complications after surgery using a robotic installation is reduced by Da Vinci 10-15%, rehabilitation and patient recovery is faster than after conventional radical prostatectomy.

The postoperative period

Competent rehabilitation after radical prostatectomy contributes to the rapid recovery of the patient and offensive stable remission. In 15-20% of cases relapse, requiring additional holding hormonal or chemotherapy.

During the recovery period after radical prostatectomy is assigned a course of treatment, aimed at overcoming the negative consequences and complications caused by surgery. The period of stay in the hospital depends on the condition of the patient, but generally does not exceed 10 days for laparoscopic and open surgery 21 days.

After a radical prostatectomy, patients undergoing surgery, oncology surgeon will give general advice and make adjustments related to diet and lifestyle.

What should be the PSA after radical prostatectomy

Prostate specific antigen is produced by the prostate gland. After its complete removal, rate of PSA should be close to zero. Value is stabilized after one month. PSA levels after radical prostatectomy observed in dynamics.

The increase in total at 2 ng / ml, indicating recurrence of cancer. The main diagnostic criteria:

• PSA dynamics - a small percentage of prostate-specific antigen produced perianal and periurethral glands. The slight increase in the amount of PSA immediately after surgery.
• The modern approach to the evaluation of PSA - are taken into account indicators of a month or more after prostatectomy. Cancer recurrence indicates a stable increase in the value of the antigen in a month or six months.

The reason for the growth of PSA - metastasis, penetrated into the surrounding tissue and lymph nodes, not cleaned during the operation.

To reduce the risk and delay the return of cancer, prostatectomy is performed in conjunction with other therapies: chemistry and the appointment of hormones.

In the treatment of prostate cancer recurrence after radical prostatectomy using beam radiation. Prior to radiation therapy requires the patient has recovered from surgery.

recovery period is from several months to six months. The period depends on the surgeon professionalism, thorough compliance with the recommendations and competently designated recovery and preventive therapy.

Complications after prostatectomy

Like any other surgery, prostatectomy leads to complications. Some of the effects are directly related to the surgery itself, others appear as secondary characters. The cause of the complications can be mistakes made during resection, so the surgeon's skill speed patient recovery depends.

Before the operation, to psychologically prepare the patient, the physician warns of possible consequences of prostatectomy. The most frequent complications are:

• Perineal pain, pelvic surgical suture. strong painkillers is prescribed in the postoperative period. Within 2-3 days the condition is stabilized enough for pain go on analgesics.
• Incontinence after radical prostatectomy - another common complication associated with changes in the structure of muscle tissue. Recovery of function occurs gradually. At first, the patient is fitted with a catheter. With the help of special exercise function returned in full. Frequent urination after radical prostatectomy gradually disappear. Reduced the number of nighttime trips to the bathroom. After restoring normal urinary drainage is removed.
• Inflammation - occurs due to bacteria getting into the cavity wounds. Inflammation also provoke the remaining pieces of the prostate gland is not removed during the operation. To prevent sepsis, appointed prophylactic antibiotic therapy. Small pus out of the seams, is a normal phenomenon, but if the situation is aggravated by a steady raising of the temperature and the fever require immediate medical assistance.
• Blood in the urine - a temporary symptom. Usually independently passes through the 2-3 days of hospitalization.
• Lymphorrhea and lymphostasis - manifested in swelling of legs. The problem is that in both cases, the lymph fluid accumulates in the lower extremities. If you do not take adequate measures in a timely manner, pathological changes can result in death of the patient.
• Sexual life - there comes a temporary impotence. Treatment of erectile dysfunction is performed taking hormone medication, performing special exercises. Restore potency fails in 70-80% of cases.
• Urinary fistula - a direct consequence of gross mistakes of the surgeon during the operation. Symptoms - violation of urination function, accompanied by a rise in temperature, the continuing long-term hematuria. Carefully examine the patient to determine the localization of violations. Thereafter, surgical closure of the fistula of the bladder.
• The necessity of wearing the band after the operation. Categorically prohibits any load on the pelvic area. After hospital discharge, attributed to the wearing of the band for a month.

Immediately after surgery, the patient is assigned a temporary disability usually, II degree. Gradually, the efficiency and performance of the basic functions, it is possible. Disability or remove another group re-classified.

Recovery of erectile function

Normalization of erectile function after radical prostatectomy lasts on average 18 to 23 months. It was developed a number of techniques that help achieve significant improvements in the patient's condition and shorten the rehabilitation period.

Modern urology explain much about erectile dysfunction after surgery and allowed to reduce the percentage of patients in whom complications are irreversible.

The main reason for the deterioration of an erection - injured during resection of the nerve bundle.

In extreme cases, after a complete postoperative recovery is performed penile prosthesis, are restored in full. If nerve damage minor, LFK is appointed and supportive therapy.

Kegel Exercises

Along with the erection restored other important features: the work of the bladder and sphincter. In traditional rehabilitation, several types of therapeutic exercises, collectively referred to: Kegel exercises. Kegel exercises were developed by a gynecologist for the normalization of the female pelvic organs. Subsequently began to be applied to men.

The advantage of Kegel exercise therapy is that simple, and the same type of exercise at the same time are used to normalize the work of several internal organs and systems. Namely:

• For sphincter - ensures the flow of blood and muscle tissue stabilization function. for sphincter exercises normalize the colon and promote relief of hemorrhoids, the constant companion of prostate tumors.
• For bladder weakness - exercise suitable for strengthening the pelvic floor muscles. Stabilized urination, it is possible to control the process. The patient learns to control the muscles of the bladder.
• Exercises to keep the urine - a complex of gymnastic movements Kegel facilitates the patient's basic functions. Gradually stops the spontaneous urination, delivers some discomfort to the patient.

Kegel exercises on recognized best restorative and preventive means of physical therapy.

Exercises to eliminate dizuricheskih events and restore potency somewhat different. Complex movements assumes no load on the pelvic region and is assigned as soon as the patient's condition returns to normal.

The prognosis after radical prostatectomy

Likelihood of recurrence of prostate cancer in the first 10 years is 27% for neoplastic processes with strict localization and 53% after the onset of metastasis. Long-term prognosis depends on the speed of recovery of the patient and adequately appointed preventive treatment.

To improve results, the treatment is carried out in several stages:

• Adjuvant hormonal therapy before radical prostatectomy - serves to reduce PSA levels sufficient to enable the operation. Taking hormones reduces prostate volume, which improves the effectiveness of surgical treatment.
• Adjuvant hormonal therapy after radical prostatectomy - is used as a preventive measure aimed at inhibition activity remaining cancer cells.
• Preventive treatment - a technique used for the further treatment of the positive effects of the surgery. Appointed 5 years after removal of the prostate, if the differentiated increase in PSA levels.

Biochemical recurrence after radical prostatectomy is observed in more than 20% of cases. Typically, the first symptoms of the disease returned - dynamics of increase in PSA 2ng / ml. monthly.

Meals after prostatectomy

Diet after prostatectomy does not differ from the diet for any cancer. In the first few days the patient is recommended to drink plenty of liquids to withdraw tissue residues from the body and prevent septic inflammation.

Daily food intake is divided into 5-6 times. Portions are doing little. The patient requires a balanced and nutritious food. During rehabilitation after surgery is optimally suitable therapeutic table №5. In the late recovery period recommended by the Japanese or Mediterranean diet.

Testimonials show that, in spite of the possible complications, prostatectomy remains the most popular surgical procedure, significantly prolongs the life of man. The number of complications and sequelae are directly dependent on the surgeon's skill.

Therefore the choice of the treatment center and the oncologist is paramount.

A source: http://ponchikov.net/health/urologiya/604-radikalnaya-prostatektomiya-pri-rake-prostaty.html

Operation "radical prostatectomy" - the best method of treatment of early stages of prostate cancer

Prostate cancer is currently ranked fourth among all cancers in men.

In connection with the improvement of methods of diagnosis of cancer (blood test for PSA - prostate-specific antigen, ultrasound through the wall of the rectum, the possibility of biopsy of the prostate under ultrasound) and an increase in life expectancy of men with prostate cancer were more likely to identify at an early stage, when possible cure patient. For this operation is conducted - a radical prostatectomy.

radical prostatectomy - option of surgical treatment, which involves the removal of the prostate gland and its surrounding organs and tissues - the seminal vesicles and lymph nodes.

effectiveness of the operation

According to the American Urological, implementation of this operation helped reduce prostate cancer mortality in 10 years by 25%. At the same time, not published any scientific work, confirming the effectiveness of the so-called "non-traditional" methods of treating prostate cancer.

Monitoring of patients who have chosen watchful waiting, showed that within 5 years distant metastases (in the bones, lungs, liver) occur in 20-45% of surveyed.

The incidence of cancer recurrence within 5 years of the surgical treatment is significantly lower than when using the radiotherapy (as brachytherapy and external irradiation).

Five-year survival rate after surgery is close to 100%, and a ten ranges from 60 to 95% depending on the cancer type and stage of the cancer process. According to German researchers, up to 75% of patients who had undergone radical prostatectomy, satisfied with their lives after the operation, and even agreed to move it again.

Indications for surgery:

1. PSA levels less than 20 ng / ml;
2. Life expectancy of at least 10-15 years (determining criteria are the average Male life expectancy in the region, the presence or absence of concomitant disease, heredity);
3. Stage T1-T3N0M0 (as oncologists denote a stage where no metastases to regional lymph nodes and distant metastases - in the liver, bone, lung, and the tumor does not extend further seed bubbles).

Contraindications to the operation:

1. Age older than 70 years;
2. Severe infections;
3. Severe cardiovascular disease;
4. Administration of drugs that lower blood coagulability (prostatectomy operation is only possible after a week after their withdrawal).
5. The presence of metastases. In this case the surgical removal of the prostate gland is performed, but is not a radical (i.e. the only curative) treatment method (further applicable radiotherapy and / or hormone-and chemotherapy).

Technique conduct operations

There are several ways to remove the prostate gland:

1) The crotch access.

The surgeon performs an incision in the perineum between the scrotum and the anus. This option is access to the prostate makes it impossible to remove the lymph nodes of small pelvis, so if cancer cells are found in them, require reoperation - lymphadenectomy.

2) retropubic access.

In this embodiment, the operation incision is made in the lower abdomen and the doctor are made available not only prostate, seminal vesicles but also and pelvic lymph nodes.

3) Laparoscopic radical prostatectomy - the most gentle method of treatment of prostate cancer. Access to the body is provided through a few small incisions, disposed in the lower abdomen, in one of which a video camera is introduced in the other - tools. The camera image is transmitted to the monitor, allowing the physician to control the process operations.

The laparoscopic technique has certain advantages over the standard - less tissue trauma, and accordingly, blood loss, decrease in the period of stay of the patient in a hospital, the ability to perform nerve-sparing surgery, allowing to preserve erectile function, smaller incidence of urinary incontinence in posleoperatsionnnom period. Currently, laparoscopic surgery is by using a special robot Da Vinci. The main difference of this technique is the absence of a surgeon in a sterile operating area - the robot movements specialist operates from another room. Precise three-dimensional visualization of the surgical field, with a 10-fold increase Image allows even more to minimize the frequency of damage to the nerve trunks and muscles pelvic floor.

Operation radical prostatectomy is the complete removal of the organ and surrounding tissues.

Obligatory stage surgery is ligation of venous plexus of the prostate - the most important measure of prevention of bleeding during surgery and the postoperative period.

The operation is completed installation of drains to a compound of the bladder and urethra, as well as Foley catheter into the bladder. A Foley catheter is removed after about 2 weeks after surgery.

Complications of radical prostatectomy

In addition to the complications possible with any surgical procedure (venous thrombosis of lower extremities, pulmonary thromboembolism branches artery, the development of infection, bleeding) may allocate the 3 most significant specific complications prostatectomy:

1) The development of urinary incontinence.

Almost all of the patients in the first few weeks after removal of the Foley catheter urinary mark urine, while after 6 months it occurs no more than 40% of patients, and in a year - only in 10-12%.

If this complication in a year is saved, the patient may need surgical treatment - installing an artificial sphincter of the bladder or the introduction of mold material under the mucous urethra.

2) erectile dysfunction.

Currently, the risk of developing this complication significantly reduced through the use of laparoscopic prostatectomy options that significantly reduce the likelihood of damage to the nerve trunks the pelvis.

there are conservative treatment for this complication (reception phosphodiesterase inhibitors, topical application vasodilators, using vacuum erector) and surgical methods - various embodiments prosthetics penis.

3) Education urethral strictures.

After surgery, can be formed urethral constriction at the spot where the prostate was previously. For the prevention of this complication, the patient is advised to drink up to 2 liters per day. Sometimes the formation of urethral strictures require surgical treatment.

A source: http://healthprostata.ru/operaciya-radikalnaya-prostatektomiya

Radical prostatectomy what are the consequences | The medic here!

It is a radical prostatectomy operational method of treatment of advanced tumors of the prostate.

The procedure involves complete removal of the prostate, in some cases, operation affects the lymph nodes and adjacent surrounding tissue.

Despite the fact that the radical prostatectomy is considered a relatively safe procedure with a minimum number of possible complications, it is carried out with high operating traumatic.

Patients undergoing prostate removal procedure should be monitored by binding stationary during the recovery period.

The postoperative period

The duration of rehabilitation after surgery depends on the following factors:

• The severity of the disease;
• The general state of the organism;
• Method of operation;
• The presence of complications or chronic diseases.

In this case, the primary post-operative period involves finding the patient under the supervision around the clock in a specialized hospital. stationary observation period can last from five days to three weeks or more, depending on the dynamics of the recovery of the body.

In the first two days of strong analgesics are administered to a patient, including - opioid. This is due to the high operating area innervated during prostatectomy. To prevent possible infections, apply broad-spectrum antibiotics in combination with vitamin preparations.

To promote healing, special drains are introduced into the surgical wound. This measure is intended to reduce the inflammatory response in the pelvic area, to improve the outflow of fluid and reduce the risk of infiltration clusters.

Further, after the operation the patient is established bladder catheterization system.

Health care workers should be carried out daily and urine analysis to monitor the patient's condition.

In the presence of severe postoperative inflammation and difficulty urinating, the catheter can be left for a certain period even after the patient has been discharged from hospital.

In general, in the absence of severe lesions adjacent to the prostate tissue, the recovery period is mild in nature.

Within a week, patients were allowed to move independently, eating is possible on the first day after surgery.

However, radical prostatectomy can lead to some complications, most of which are completely disappear after the recovery period.

Possible postoperative complications

Radical prostatectomy is the most effective treatment of neoplastic diseases of the prostate. The procedure itself is performed by a well-established technique in which the likelihood of intraoperative complications is minimized.

The main issue, which is always considered at a joint consultation with the patient his doctor: "What are the consequences of prostatectomy?"

All the negative consequences of this operation is usually detected at an early stage of the rehabilitation period.

These include:

• Venous bleeding;
• Urinary incontinence;
• Erectile dysfunction;
• Related infectious diseases.

Immediately after the operation, the operating wound can bleed profusely. However, such a bleeding wound easily and does not cause any adverse effects.

Infectious lesion occurs on a background of severely immunocompromised or in violation of sterile surgical operating room.

As a rule, the infection is completely stopped by antibiotics of a wide and a narrow range in the first days of occurrence.

Serious complications and their prevention

Thus, the most severe early impacts of prostatectomy - urinary incontinence and erectile dysfunction.

The development of incontinence may be due to three factors:

1. Removing a portion of the urethral channel;
2. Nerve damage;
3. Stress state of the organism.

Typically, incontinence completely cured on their own during the first two months after surgery. During this period, the patient can use sanitary napkins.

The risk of such complications is directly related to the general state of the patient and his or her age. In severe cases, it may require the installation of special clips or an artificial urinary sphincter.

Prevention of urinary and palliative care may be to appoint a special physical therapy to strengthen the pelvic floor muscles.

Erectile dysfunction - the most terrible and unpleasant complication of prostatectomy. Unfortunately, according to medical statistics, erectile dysfunction occurs in 40% of patients.

The reason for such frequent development of impotence after surgery is associated with the close proximity of the prostate to the nerve clusters of small pelvis.

In step inevitably damaged nerve fibers, resulting in partial or complete loss of erection.

As is the case with incontinence, the emergence of erectile dysfunction are most susceptible to the elderly and patients with reduced immune response. Currently, in order to prevent this complication, applied a technique of penile rehabilitation, which is aimed at restoring the cavernous tissue and strengthen the neurovascular bundles.

In rare cases, radical prostatectomy can lead to more serious complications.

Among them we should especially mention the following:

• Sclerotic lesions of the bladder neck;
• Splicing urethral lumen;
• Chronic inflammatory reaction.

As a general rule, the risk of such complications is minimal, and their treatment is carried out exclusively by surgery.

prostatectomy

Surgical intervention for partial or complete removal of the prostate in identifying benign or malignancy - prostatectomy, requires preparation of the patient and careful survey.

Excision of the patient's body takes place under general anesthesia. Having decided on the operation, it is necessary to weigh all the "pros" and "cons", because for some reason sometimes the effectiveness of intervention is questionable and can cause the body more harm than good.

Methods of performing prostatectomy

There are several types of surgery for the removal of the prostate gland in men, each of which has its advantages and disadvantages. The method selects a specialist, based on the condition of the patient, it can be:

• retropubic way to remove the prostate;
• LRP conducted by radical route;
• perineal resection;
• laparoscopic surgery using innovative equipment, "Da Vinci".

Each of these methods requires general anesthesia and patient preparation prior to radical surgery and subsequent medical support in a hospital after surgery period.

retropubic prostatectomy

Expected execution section within 10 cm in the lower abdomen in a direction from the navel to the pubic bone. Specialist apart surrounding tissues, which allows access to the seminal vesicles and prostate. After ligation of vessels feeding the prostate, there is a complete or partial removal of the organ.

The surgeon aims to leave no damage bundle of nerve roots responsible for the retention of urine in the bladder and erection. The urethra is sutured into the bladder, urine diversion is done through a catheter inserted.

If radical retropubic prostatectomy is successful, the rehabilitation takes 7 days, the reduction in function of the patient urine catheter is removed.

perineal prostatectomy

If radical surgery is performed horizontal incision between the scrotum and the anus of men. This method is effective in the development of prostate cancer stage I-II, when the area spread of cancer cells is not so great and no metastasis to nearby organs.

But this method of removal of the prostate gland is not possible when a volume exceeding 50 cm3. Such intervention does not apply if there is a need to remove together with the prostate and lymph nodes.

As radical prostatectomy using this method is not always possible to keep the nerve bundle that is responsible for erection and urination, which significantly affects the quality of life of men in the future.

Laparoscopy for radical prostate removal

A viable alternative to traditional intervention today is a minimally invasive surgery to remove the prostate gland.

It is noted that laparoscopic radical prostatectomy - is a gentle modern method allows an intervention into the body with minimal trauma to the tissue.

What is laparoscopy? This application is a modern device (laparoscope), which is equipped with minivideokameroy and is used to control the actions of the surgeon.

Through incisions in the lower abdomen injected apparatus with surgical instruments that produced prostate separation from the surrounding organs and excising it with minimal damage tissues. Laparoscopic removal of the prostate adenoma using innovative technologies can reduce stay patient in a medical facility in the shortest possible time to restore the vital function in men.

Removal of the prostate with the use of complex "Da Vinci"

When laparoscopic removal of the prostate using a robot with microsurgical instruments, replacing the hand and the eye specialist. Modern equipment allows us to multiply the operating field, providing a three-dimensional image, which allows the surgeon to operate with confidence in the course of the intervention.

Manipulations made precisely because of the filter, which suppresses the tremor of the hands during surgery. This method is able to replace radical prostatectomy, for jeweler's work-assistant robot allows remove the diseased organ and responsible for urination if necessary, and lymph nodes, without affecting the nerves and erection.

After extraction using prostate urethra anastomosis joins the bladder.

Minimally invasive tsistprostatektomiya among the advantages is:

• sparing injury to tissue which is accompanied by minimal blood loss;
• It reduces the risk of complications after prostatectomy due to the precise manipulation of the apparatus;
• high probability of keeping a normal erection and quick recovery of urinary function;
• the minimum rehabilitation period after the intervention;
• a high level of patient tolerance.

Laparoscopic surgery to remove the prostate today recognized as the least traumatic, but the price in the leading clinics for this type of intervention is quite high.

Contraindications and indications for prostatectomy

Manipulation to remove the prostate are recommended for patients who:

1. revealed malignancy in the prostate;
2. advanced stages of BPH, when other methods of treatment are not acceptable;
3. developed acute stone disease;
4. diagnosed prostate fibrosis;
5. It found extensive prostate abscess.

But in some cases, surgery is contraindicated due to serious illness of the patient or his age features. So radical prostatectomy is not performed when:

• renal or liver failure;
• the threat of a man's life from general anesthesia;
• reaching the age of the patient 70 years of age;
• dekompensatsionnoy activity of the heart;
• respiratory failure.

The attending physician must weigh the risks adequately and competently prepare the patient for surgery.

What are the consequences of prostatectomy

Depending on what method of surgery has been chosen, there is the duration of recovery and the basic functions of the body.

If successfully been performed a radical prostatectomy, the postoperative period it will take longer than with the assistance of a laparoscope. At the initial stage it is monitored in the blood PSA level, which is lowered after removal of the prostate cells.

If successful outcome, and connecting methods of radiotherapy and chemotherapy drugs, supporting the human immune system, the PSA level in the first months set in the range of 0.2 - 0.4 ng / ml.

If the indicators are at 6 and 12 months significantly grow, it testifies to the development of metastases. With such consequences prostatectomy, the patient is prescribed a course of chemotherapy to go next, and irradiation.

If the successful outcome of the vital function after radical prostatectomy come back to normal, suggesting that the recovery of the patient, capable of leading a full life.

rehabilitation period

Recovery after radical prostatectomy has a long and includes significant limitations than after laparoscopic surgery.

In the first case, the patient's hospital stay is required for 2-3 weeks, while in the second case it is discharged on the 10th day. Lymphocele mainly takes place on the third week after the surgery.

Rehabilitation after radical prostatectomy, and includes various methods of treatment of malignant neoplasms, prescribed by the oncologist.
The patient should be prepared for the possibility that:

• Postoperative urine output is made through a catheter;
• You will need to take pain medication and antibiotics for the prevention of infection and rapid wound healing;
• Daily laying fresh sterile dressings, processed seams to be removed on day 7;
• You have to endure a diet for maximum intestinal discharge, thus preventing flatulence and constipation.

Get up and walk the patient can at the second day after surgery. After 45 days with proper treatment and compliance with doctor recommendations to normalize urination and recovery of erectile function, key indicators will meet the level of activity of men before surgery.

When you save the nerves during prostatectomy recovery rate of erection in men greater than 50%. But rehabilitation activities take place under the supervision of the attending physician with the connection of drugs that contribute to the regulation of potency.
When antibiotics are prohibited to consume alcohol.

The patient does need to focus on a set of exercises to strengthen the pelvic floor muscle. It is proposed to elaborate a complex of exercise therapy to the patient's individual characteristics. Positively marked Kegel exercises to help bring in the necessary muscle tone. 3-6 months need a man to come into an active form.

Working in the office can proceed to his duties at 1 month after surgery and in 2 months you can start work with physical exertion.

complications

The patient should be prepared that not every surgery ends with a positive outcome. Complications of radical prostatectomy, which needs to know the patient and his relatives:

1. There is a risk of lymphocele when lymphatic fluid accumulates in the form structures impressive size. Cysts can disappear within 3 weeks after surgery for normalization of lymphatic drainage, or may require a new surgery to remove them.
2. In the event of damage to the nerve roots is observed urinary incontinence after radical prostatectomy. It threatens the fact that the patient will be forced to use some time urinal catheter.
3. Tsistprostatektomiya sometimes threaten herniation between the urethra and the bladder.
4. There is a risk of blood clots in the pulmonary artery. As with any surgical intervention under anesthesia, thromboembolism can become a cause of death.
5. In rare cases, when the body behaves inappropriately, threatens the patient disability.

But despite the risks, prostatectomy today is a chance to extend the life of the patient, the possibility of overcoming prostate cancer and return to full existence. The optimal method of surgery experts selected on an individual basis.

A source: http://medic-tut.ru/radikalnaya-prostatektomiya-kakovy-posledstviya/

Treatment of prostate cancer radical prostatectomy

Radical prostatectomy is an operation which is performed as a result of removal of the prostate and seminal glands. She performed perineal and retropubic procedures. At the moment, it is increasingly used laparoscopic removal of the prostate.

The use of a little-known techniques do not always lead to the speedy recovery of the patient.

A significant reduction in the rehabilitation period depends on many factors, starting with the right diagnosis, ending the professionalism of the doctor and the selected method of operation.

Surgery to remove the prostate was first held back in 1866. After some time, we began to use perineal and retropubic prostatectomy techniques.

The big drawback of these transactions were the consequences of which were expressed in erectile dysfunction, impotence and incontinence. Thanks to the development of medicine in 1982, researchers have described in detail the structure of the venous plexus and neurovascular bundles.

This enabled, in turn, significantly reduce the number of unwanted consequences, as in surgery managed to circumvent all the important sites.

Currently prostatectomy is the only treatment for prostate cancer tumors with a positive result, occurring in almost 100% of patients. But, as it turns out, this method is very complex and has a long learning curve.

Among prostatectomy techniques most often used is retropubic. The thing is that using perineal access, there is a high probability of incomplete removal of the cancer cells.

This leads to the appearance of metastasis, and disease spread to healthy tissues and organs, neighbors next to the diseased prostate. Also recently gained special popularity laparoscopic prostatectomy.

European centers are increasingly prescribe it to patients, since it is not as costly and requires less time for rehabilitation.

The main types of surgical approach

As mentioned earlier, at the moment the most popular methods of surgical access during radical prostatectomy are:

• the crotch;
• Laparoscopic;
• abdominal.

perineal method

Perineal approach with radical prostatectomy involves creating an incision in the area between the anus and external genitalia of men. Thereafter, the separation of tissue, thereby making it possible to reach the prostate gland.

Now perineal radical prostatectomy method used relatively rarely. The reason for this is some technical difficulties, which often do not allow you to save a bundle of nerves along the way.

Also, this method does not give full access to the lymph nodes, which can be affected by cancer cells.

In case of favorable conditions, they can scatter the metastasis of all the organs that will undoubtedly lead to death.

The laparoscopic method

Laparoscopic prostatectomy method involves making a small incision in the abdominal wall, and putting them in small surgical instruments. Monitoring the operation is carried out using special probes, operated broadcasting space on the small screen.

Although laparoscopy has a very small number of complications, and requires a short recovery time, the exact consequences of the doctors still are not known yet. It is also worth mentioning that it can be applied only when the prostate weight does not exceed 100 grams.

abdominal access

Abdominal access allows you to perform retropubic radical prostatectomy. It involves creating a cut on the patient's navel to his pubic bone. After dissecting the tissue apart, and made vessel ligation of the prostate gland.

This technique makes it possible to completely preserve the nerve bundle, which is responsible for erections and bladder control. Thus prostate weight may be greater than 100 grams.

Advantages and disadvantages of retropubic prostatectomy

Despite the effectiveness of the laparoscopic method, accurate results of this operation are still at a formative stage. For this reason, the actual replacement retropubic prostatectomy is still there.

In retropubic prostatectomy have a large number of advantages.

Among them are:

• There are no severe complications in the postoperative period;
• a high percentage of survival in the long term;
• accurate prediction;
• if necessary lymphadenectomy is performed;
• detection of recurrence in early stages and the possibility of use of other therapies.

Despite the efficacy of retropubic prostatectomy, it is not without drawbacks.

Among them are:

• the presence of the risk of death in the postoperative period;
• complications due to incomplete removal of the organ;
• urinary incontinence and erectile dysfunction due to surgeon error;
• complications such as postoperative hernias;
• the presence of cutaneous scar;
• disability at the time of admission and during the postoperative period (rehabilitation).

All these drawbacks simply overlap the advantages of the method of operation. And when you consider that the percentage of abnormalities in the form of urinary incontinence and impotence are very small, the main concern should be just about complete removal of the cancer cells.

When necessary lymphadenectomy?

It often happens that after a radical prostatectomy, the cancer cells go to the lymph nodes. It lymphadenectomy avoids metastasis, resulting in a 100% cure.

Lymphadenectomy can not be carried out. It all depends on the stage and neglect of prostate cancer. Only after careful research and conclusions of experts can talk about this or that method of surgery.

Treatment of metastases, common long-lymph nodes, hold hormone.

After radical prostatectomy

After surgery, the patient is placed in a special chamber. Here it can be from 7 to 21 days. If the doctors found complications, this period is increased to the point until a normalization of the patient's condition. In the future, regular monitoring is conducted for them.

It is worth noting that during the operation in the bladder catheter is inserted Folleya. It is located in the body of patients operated for several weeks. Using this catheter is able to control discharge of urine and its nature.

Very often after surgery observed severe pain at the site of prostate removal. They were jammed with the help of non-steroidal anti-inflammatory drugs and analgesics. All drains that are left after surgery, with no problems, purulent secretions and blood are removed on the fourth day. If there are no further complications, the sutures are removed on the second postoperative week.

The day after surgery, the patient may freely eat. Walking has entered the corridor after removal of drainage. But exercise the patient can be taken 2 months later. In this case, it is obligatory to use a bandage.

Complications of radical prostatectomy and their probability

According to studies, the overall percentage of complications in radical prostatectomy is not more than 10%. This rate depends not only on the correct diagnosis, but also from the experience of the surgeon who carries out the removal of the prostate gland.

The final result of complications include:

• death is 0-2.1%;
• opening heavy bleeding during the early post-operative stage is 1-11%;
• damage to the rectum in the range 0-5,4%;
• the likelihood of deep vein thrombosis of the pelvis is 0-8,3%;
• lymphocele seen in 3% of cases;
• stress incontinence - 4-50%;
• total incontinence can reach up to 15.4% of the cases;
• erectile dysfunction and impotence can be in the range 29-100%;
• inguinal hernia appears in 2.5% of cases.

other complications

It is worth noting that rarely happens during radical prostatectomy is ureteral injury. Here doctors undertaken suturing (with minor injuries) or held ureteroneocystostomy.

If we compare the rate of restoration of function of holding urine and erection, the first has a much shorter period of time. So, more than half of the patients immediately after the surgery are free to control urination. The remaining patients tend to recover a hold urine for a year after surgery.

Here the result also depends on the age of the operated. If patients take up to 50 years, almost 95% immediately able to hold urine. Those whose age is "passed" for 75 years, in 85% of cases may suffer from varying degrees of incontinence.

If control urination is not successful, the doctors put an artificial sphincter.

With regard to impotence, then it had previously occurred in almost all operated.

The reason for this result is a weak education of doctors, lack of ganglia data and their impact on sexual function.

Over time, the situation has improved considerably, which in turn made it possible for patients to avoid the appearance of impotence. But the likelihood of such effects is still at a very high level.

Unfortunately, very often the case that the type of tumor does not allow to leave kaveroznye nerves. This can be avoided only by removing a part of them. Thus preserved partial functionality of the male reproductive organs, and the risk of relapse is significantly reduced.

Impotence can be avoided, and also the introduction of alprostadil into the corpora cavernosa. This is done in the early postoperative period, and also allows you to save a man's sexual function.

In the postoperative period, some men suffer even a number of unpleasant complications such as constipation and diarrhea. Well, infertility is guaranteed to all patients who have completely removed the prostate.

Here, the reason for this effect is the fact that the gland secretes a secret in which they live and move sperm.

With the absence of juice ejaculation becomes impossible, and as a result, there is a complete infertility.

conclusions

On the basis of all the information provided in this material, it can be argued that Radical prostatectomy is one of the best methods to remove prostate availability cancer.

To her resorted to several reasons, among which:

1. The ability to remove the cancerous tumor and a full recovery in a very short period of time.
2. The ability to save an erection and sexual function (except for the appearance of 100% of infertility).
3. Very low mortality (median survival of 10-15 years).
4. Low probability of metastasis.
5. However, to maximize the operation needs highly qualified surgeon and the correct definition of the type and stage of the cancer.

A source: https://kaklechitprostatit.ru/lechenie/radikalnaja-prostatektomija.html