» Prostatic Hyperplasia
 » Obstruction of the ureteropyelic union
 
Prostatic Hyperplasia
"This is maybe one of the most frequent urologic illnesses. It consists on the growth of the prostate at the expense of healthy tissue. It is manifested by means of urinary symptoms, since all men will invariably have prostate growth after the age of 30."

Demography and risk factors:


The diagnosis of symptomatic BPH (Benign Prostatic Hyperplasia) is carried out on the severity of the symptomatology and physical test. Not all the prostate growths cause symptoms.
The BPH is very common. The appearance of histological BPH (diagnosed under the microscope) in the autopsy studies is the following one:
20% in men of 41-50 years old
50% in men of 51-60 years old
90% in men older than 80 years old
Although the symptomatic BPH is less common, approximately 25% of the men at the 55 years old also show symptoms of BPH, and the 50% of men of 75 years old, also do it.

The only risk factor proved for the BPH is the age and the male gender. However, children and brothers of patients with BPH have a greater risk to develop BPH.

The causes of the BPH are not very well known. It is believed that the BPH is the result of hormonal changes and the changes in the prostate produced as a part of the normal aging process. Therefore, there is not a real and effective prevention of this illness.
.

 
   
Transurethral Resection of Prostate  

Symptoms

Decrease in the strength and magnitude of the urinary stream
Hesitancy to begin the urination
Dribbling after finishing urinating
Bled in the urine
Severe urinary retention
Urinary bladder stones
Urinary tract infection
Voiding many times during the night (nicturia)
Renal failure

Treatment options
At the moment, there are several treatment options for the prostatic hyperplasia
Observation:
  These treatments are offered to those men with light symptoms

Treatment with medication:
 
The specific therapy is based on the seriousness of the symptoms of a man, his general health situation, the size of the prostate, the geometry (shape) of the prostate and the patient's preference. The medications are, in general, the first treatment option. The therapy with alpha-adrenergic blockers, or 5-alfa-reductase inhibitors, can be enough.

Endoscopic surgery:
 

 

It is carried out through the penis, without wounded, with a device that takes a fiber optic vision system and a resector that can be of several types: Microwaves thermotherapy, laser holmium, and transurethral resection of conventional prostate, transurethral resection of prostate with bipolar energy, are the different resection types that we offer in the Institute, besides High Frequency Ultrasound (HIFU). The transurethral resection of the prostate requires staying in the hospital during the night.  

The most important aspect you should keep in mind is that in this kind of surgery the prostate is not totally removed; only the part of it that produces the obstruction, will be extracted. 

These procedures are chosen according to the opinion and criteria of the doctor, as for the size of the prostate, bled risks, and other illnesses that could affect the patient's recovery.



High Frequency Ultrasound (HIFU)
Prostatectomy by means of either laparoscopic, robotic or conventional surgery


For surgery
If you have a cardiovascular problem one must first be reviewed by their cardiologist or general practitioner. There are many sophisticated equipment, with which it can perform endoscopic surgery safely for you.

Preparation for surgery:
Do not drink neither eat food eight hours before the surgery
The aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, E Vitamin, Ticlid, Coumadin, Lovenox, Plavix and some medications for the arthritis can cause hemorrhage and should be avoided 7 days before the date of the surgery. Your pharmacy or the medical prescription can inform you if the medications that you are taking are "lightening" your blood.
Do not omit any medication with the prescribing doctor to obtain his/her approval.

Possible risks and complications:

Bleeding:
  It is very frequent that most of the patients present blood in the urine the subsequent first days to the surgery, however less than 1% of the patients require a blood transfusion.

Urinary tract infection occurs in 5-10% of the patients
Retrograde ejaculation:
  During the ejaculation, the semen can return to the bladder. It will go out the next time of urination. This doesn't have any effect on the capacity to obtain or to maintain an erection, or of experiencing an orgasm. This will only affect the capacity to have children.

Urinary incontinence - the urine loss associated with the need of urinating can happen for a couple of weeks after the surgery. It is expected as a bladder irritation of the procedures and it is solved with a catheter diminishing. The long term urinary incontinence can happen in 2% of the patients.

Urethral stenosis:
The scar tissue could require additional surgery. This happens in less than 1% of the patients


After the surgery:

Pain control:
Usually, there is not pain after this surgery except for some smarting when urinating that is expected and it diminishes with urination. The catheter that is left could cause bladder spasms (inferior abdomen cramps) that will cease after removing the catheter.

Shower:
You can take a shower at home. If you are being discharged from the hospital with a catheter, don't disconnect the drainage bag of the catheter. Pay attention to the area where the probe enters in the tip of the penis. After the shower, dry very well the area where the probe enters as well as your drainage bag.
Activity:
It is very important to take walks. To remain sitting down or at bed should be avoided. To go up stairs is much recommended. To drive should be avoided at least during two weeks after the surgery. To bounce in a car, even as passenger, can cause a hemorrhage. It is contraindicated to lift heavy objects or exercising (to run, to swim, walkway, bicycle) during four weeks or until the doctor suggests it. You will be able to work again in approximately 3 to 4 weeks

Sexual activity:
You should avoid the sexual relations during 6 weeks after the surgery.

Diet:
 
Your appetite can diminish after the surgery, this is normal. Try to eat small portions of food.

Avoid the constipation:
You can take laxatives or a laxative if it is necessary. Don't use enemas. Make sure of including fruits, vegetables and fiber in your diet. You should avoid the effort of having an intestinal evacuation since this can increase the bled.

Fever:
 
If you have fever of more than 38.5ºC, call your doctor. Make sure to accomplish the complete cycle of antibiotics prescribed by your doctor.

Urination:
 
It is normal to see blood in your urine in an intermittent way. This can happen in an intermittent way during 3-4 weeks after the surgery. Increase your consumption of liquids, if it is not medically contraindicated, with the purpose of diluting the urine. If your urine seems to be thick and with blood, or it presents a great quantity of blood clots, call your doctor. You will also have the urgency to urinate (a quick need to urinate with little previous warning) when you still have a catheter. This will be solved with time. Maybe you will need medication.

Imprimir esta página