radical prostatectomy

Radical prostatectomy is an operation in which the prostate gland is removed and the tissue surrounding it (seminal vesicles, paraprostaticheskuyu cellulose), local lymph nodes when necessary. The indications for this type of surgery are benign cancer (advanced forms) and prostate cancer.

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Israeli surgeons perform radical prostatectomy in the following cases:

  1. Number of prostate-specific antigen least 20ng / ml (increase indicates tumor development rate - from 0 to 4 ng / ml).
  2. Gleason score - 8 - 10.
  3. Extracapsular growth of malignant tumor is limited, there is a one or two sides in the fatty tissue.
  4. Malignant neoplasm affects both lobes of the prostate tumor is more than 5% of resected tissue.
  5. Cancer is a low-grade, but is 5% of resected tissue.
  6. The duration of the patient's life (expected) with a highly differentiated cancer more than 15 years. He was diagnosed with prostate resection and occupies 5% tissue sample.

There are some contraindications for prostatectomy: no easy access to the prostate gland due to anatomical reasons or scars, the small size of the prostate, disorders of the respiratory system and the heart in which to carry out the operation and use anesthesia can be dangerous for the patient's life.

Prostatectomy preceded by a diagnosis that includes blood tests (tumor markers, PSA), transrectal ultrasound, electrocardiogram, test of urinary tract function, prostate biopsy.

Before carrying out operations with anesthesia the anesthetist discussed embodiments based on the diagnostic data and the history of previous disease. Can be applied to general anesthesia, local anesthesia is cavernous, spinal anesthesia. The most common type is the epidural or spinal anesthesia, which is characterized by lower risk of complications, as well as effective pain relief after surgery.

Operation radical prostatectomy performed using two approaches: through an incision in the abdomen (retropubic) and a crotch area (perineal).

Radical retropubic prostatectomyOperation radical prostatectomy

This type of prostatectomy makes it possible to remove the prostate gland of considerable size, excised parallel to regional lymph nodes. It is used more often because it gives the opportunity to assess the state of the pelvic lymph nodes.

Enhanced pelvic limfadetektomiyu operate at diagnosis localized prostate cancer moderate risk if the probability of proliferation of lymph node metastases of more than 7%.

Retropubic radical prostatectomy: course of the operation

The lower midline incision performed, the length of which is 7-9 cm. Next, the surgeon cuts through the layers of the abdominal wall tissue, separating the neck of the bladder, prostate and iliac vessels of large dimensions, which are located along the pelvic lymph nodes.

If necessary, prior to prostatectomy, lymphadenectomy is performed, during which the regional lymph nodes are removed. This procedure is preceded by prostatectomy.

After that, the mobilization and resection of the prostate to the seminal vesicles. During the operation, part of the prostatic urethra to the prostate removed, traversing the urethra. Then superimposed vesico-urethral anastomosis, ie sewed the remaining portion of the urethra to the bladder neck. It should be carried out hemostasis and drainage of the prostatic bed, layer by layer closure of the surgical wound. Surgery lasts two and a half - three and a half hours.

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Radical perineal prostatectomy

Using this surgical technique produce removal of the prostate via an incision in the perineal region.

For perineal access is characterized by several advantages:

  • less blood loss;
  • reduction of operation time;
  • easier access to the prostate gland;
  • less pain in the postoperative period;
  • a shorter hospital stay and rehabilitation.

The disadvantage of this technique - the inability of local excision of lymph nodes. Furthermore, applying this technique is difficult to work with nerve fibers adjacent to the prostate gland and are responsible for potency.

Contraindications to access the crotch are: ankylosis, severe arthritis of the joints of the pelvis, the presence of artificial prostheses. Difficulties arise when a large amount of the prostate gland. In this case, the retropubic prostatectomy or before surgery is performed course of hormone therapy that reduces the size of the prostate.

radical prostatectomyPerineal radical prostatectomy: course of the operation

The patient is in the high lithotomy position. Running U-shaped incision in the crotch area, between the anus and the scrotum. Dissecting the tissue layers, is visualized prostate and seminal vesicles. The surgeon removes the prostate to the prostatic urethra, urethral segment remaining stitches to the neck of the bladder. The bladder catheter is installed. The wound was sutured in layers. During the operation radical prostatectomy - two - two and a half hours.

nerve-sparing prostatectomy

Currently, the use of both methods of prostatectomy in Israeli hospitals makes it possible to preserve erectile function. This is achieved by storing the nerve fibers of the prostate gland. If this is not possible for prostate cancer, is fed adjacent nerves. Indicator probability erectile dysfunction after radical prostatectomy operations in Israel is 3%.

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After radical prostatectomy

In most cases, after the operation patients for 4-7 days stay in the hospital, because the procedure - an extensive, and after prostatectomy they need strong painkillers. It also requires strict control, the maintenance of bladder function, control fluid balance in the body.

rehabilitation after radical prostatectomy in Israel is as follows:

  1. In the first twenty-four hours the patient's diet consists of a liquid and light food, it occasionally is transferred to a sitting position.
  2. The following day, he gradually moves to a normal diet. If not detected in the urine of blood, urethral catheter is removed.
  3. During the third day of increased activity of the patient. Operating doctor shall inspect, remove drainage, in the absence of complications and additional patient readings are sent home. As a rule, the maximum recovery period is considered to be four weeks, when the patient may have to return to their previous physical activity.

Complications after radical prostatectomy and benefits of treatment in Israel

After radical prostatectomy  Applying advanced technology in the course of the operation, the Israeli doctors do not allow bleeding in most cases. During surgery haemorrhage stopped cauterizing vessels special precision laser. Avoid infection due individually selected drug maintenance operations and quality postoperative diagnosis.

Perhaps some side effects: frequent urge or temporary urinary incontinence can be observed for some time after the operation due to the narrowing of the bladder neck. Previously common complication were changes in the urethra structure observed narrowing of its walls after catheterization process. However, in Israel clinics applied bestravmatichnaya catheter introduction technique, which in combination with drug therapy and special treatment fluid intake prevents the development of this complication.

Two of the three patients have retrograde ejaculation, but this side effect does not inhibit sexual activity and is not considered serious. In less than 1% of cases develop severe complications: stroke, thrombosis, embolism pulmonary arteries and others.

Before discharge from the hospital for each patient selected individual procedures, which it will need to perform. Their goal - to restore the function and urinary continence. This system is a metered load, pelvic floor muscle exercises, plus provides recommendations for age, restoring sexual function. According to the incident three months after surgery, the patient should have a blood test for PSA. Then repeat it every 3 months during the year after prostatectomy and then every 2 years.

Indicators of life after radical prostatectomy surgery, carried out in medical institutions of Israel, are very high - up to 92% when there is a complete post-operative healing of all appeals. SpecialistLeon Agulyansky- one of the best doctors in Israel, which is engaged in treatment of bladder cancer. His methods of treatment allow the patient to recover in a short time.

Israeli clinic is also used more modern, minimally invasive - laparoscopic and robot-or robotic radical prostatectomy. Used in the course of its own unique development operations - medical sensors with artificial intelligence tools for guidance to the tumor foci.

Complex work with the patient experience, modern technology and the latest developments of the Israeli doctors can guarantee the recovery and return to normal life after the operation radical prostatectomy.

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