Prostate adenoma or benign prostatic hyperplasia (BPH) is a noncancerous increase of the prostate gland size, which leads to deterioration of life quality in men. Drug therapy is effective in a limited number of patients at the early stages of the disease. In other cases, the preference is given to surgical techniques. According to the American Urological Association, TURP is the most common and preferred surgical treatment for BPH.
Indications for transurethral resection in BPH
The purpose of transurethral resection in patients with prostate adenoma is restoring normal urination and preventing the genitourinary system complications. Particularly, TURP is carried out in presence of the following symptoms:
- Frequent urination, urinary urgency
- Nocturnal enuresis (in excluded diabetes mellitus)
- Weak or intermittent urine stream
- Difficult and slow urination
- Difficulties in starting urination, the need to strain pelvic floor muscles
- Feeling of incomplete bladder emptying
- Prostate bleedings
Due to the restoration of normal urination, TURP prevents secondary lesion of the kidneys, formation of calculi in the kidneys and bladder, frequent and recurrent urinary tract infections.
Preparation for transurethral resection of the prostate
Preparation for TURP in Germany significantly reduces surgical risks and facilitates the postoperative period. Few weeks before the intervention, you will undergo a complete physical examination and, if necessary, receive recommendations for the compensation of diabetes mellitus, normalization of blood pressure level, improvement of the external respiration function, etc. The doctor will also recommend you to stop smoking.
Few days before the intervention, it is necessary to cancel the intake of such drugs as:
- Anticoagulants and antiplatelet drugs (for example, clopidogrel and warfarin)
- Nonsteroidal anti-inflammatory drugs (for example, aspirin, ibuprofen, naproxen)
- Vitamin E
A broad-spectrum antibiotic is additionally prescribed for the prevention of urinary tract infections.
Life during first days after discharge from the hospital is also worth planning in advance. For instance, you will not be able to drive a vehicle and get home by car on your own.
The risks of transurethral resection of the prostate
Like any surgical intervention, the transurethral resection of the prostate gland has certain surgical risks. The physician will discuss with you the following possible risks and methods of their prevention in advance:
- Temporary difficulties of urination. During the first few days after surgery, you will urinate via a catheter.
- Dry orgasm. After prostate surgeries, the direction of sperm movement during ejaculation changes. The sperm enters the bladder retrogradely. This factor does not affect the ability to achieve orgasm, but it becomes an obstacle in planning pregnancy.
- Erectile dysfunction, which occurs due to the injuries of nerve endings.
- Low sodium concentration in the blood or TUR syndrome. During the TURP, the surgical area is washed with a large amount of fluid, which is partially absorbed into the systemic circulation. This leads to impaired blood electrolyte levels and could potentially be a life-threatening condition. While using bipolar resectoscopes, the risk of this complication is excluded.
- Need for repeated treatment due to further increase of the prostate gland size or urethral stricture (narrowing).
The surgical risks of transurethral resection in Germany are minimal. Work of German hospitals is characterized by a low percentage of complications and a high percentage of successful interventions.
The technique of transurethral resection of the prostate
TURP is carried out on an inpatient basis, under general or spinal anesthesia. After anesthesia completion, the resectoscope is inserted into the urethra. A resectoscope is a thin metal tube with a light source, a camera, and a wire loop (similar to a scalpel). Due to its miniature size, the equipment is placed in the urethra without additional incisions.
The resectoscope moves up the urethra and reaches the enlarged prostate. After that, an electric current is passed through its loop. Due to this the loop acquires the ability to cut off small pieces of prostate tissue. The removed tissues are washed off into the bladder and remain there until the procedure completion. Simultaneously with the prostate resection, the electrocoagulation of blood vessels is carried out. An electric current "closes" the blood vessels and stimulates blood clotting. Due to this, reliable hemostasis is provided during the procedure, risks of intraoperative and delayed hemorrhage are minimal.
In Germany, transurethral resection is performed with the help of bipolar resectoscopes. This means that the electric current does not pass through the patient's body, injuring the surrounding healthy tissues, as in the case of using monopolar equipment. In bipolar resectoscopes, both electrodes are located on the loop of the device, so the current affects only the resected areas of the prostate. In addition, while using bipolar systems, TURP can be performed in patients with the implanted pacemakers.
The procedure takes from 90 minutes to 2 hours. In addition to minimal invasiveness and quick relief of symptoms, TURP has a number of the following benefits for urology specialists and patients:
- Direct access to the prostate
- Excellent imaging with endoscopic camera, which can be combined with the ultrasound guidance
- It is carried out at any degree of prostate enlargement, any volume of gland can be removed during one procedure
- It can be carried out simultaneously with other operations, for example, with the removal of small calculi from the bladder
- Effectiveness of the procedure and absence of long-term complications is confirmed in clinical trials
- It is extensively used in clinical practice, specialists have rich relevant experience
The course of postoperative period
Treatment of benign prostatic hyperplasia in Germany does not come to an end when a patient is discharged from the hospital. Each man receives detailed recommendations for care during the postoperative period and follow-up monitoring.
First of all, you need to drink enough water for the active urination and flushing out blood residues from the bladder. This serves for the additional prevention of urinary tract infections and restores the natural urinary reflex. For the same purpose, it is recommended to exclude dehydration medications (for example, antihistamines) and substances affecting the renal vessels (for example, alcohol, caffeine, nicotine). If necessary, you can take painkillers.
A aptient does not need to keep a special diet, but the preference should be given to food rich in cellulose and dietary fibers (this normalizes defecation and prevents constipation). Within a few weeks after discharge, it is recommended to avoid prolonged and hard physical work, sexual intercourse.
In general, the symptoms of prostate adenoma gradually disappear within 2-8 weeks after surgery. You will feel significant relief immediately after the removal of urinary catheter.
Organization of medical treatment in leading German urological centers
The leading German urological centers admit German citizens and international patients. If you do not have experience in the treatment in foreign clinics or you want be sure that the medical program is organized thoroughly, you can use the services of Booking Health. Booking Health is the official partner of leading German clinics and a certified provider of treatment in Germany for patients from 75 countries.
The specialists of Booking Health will help you with such important issues:
- Selection of the right hospital based on the annual qualification profile
- Establishment of direct communication with your physician
- Preparation of a medical program in advance, without repeating previous examinations
- Provision of favorable costs for a surgery, without overpricing and additional coefficients for foreign patients (saving up to 50%)
- Booking the appointment with a doctor on the necessary date
- Monitoring of the medical program at all its stages
- Assistance in buying and forwarding of medicines
- Communication with the hospital after treatment completion
- Control of invoices and return of unspent funds
- Organization of additional examinations
- Top-class service: booking hotels and plane tickets, transfer organization
Please, leave a request with a description of medical problem and contact information on the Booking Health website, and wait for a call from the specialist of our company within 24 hours.
Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova