Benign Prostatic Hyperplasia Surgery And Radical Prostatectomy

Posted on March 2, 2009 by mkr in Mens Health

The operation which is performed to cure BPH is called as ‘Prostatectomy’.
The term ‘Prostatectomy’ is a misnomer, as it is not an excision of whole of the prostate, but enucleation of the nodular hyperplastic prostatic tissue, keeping intact the surrounding surgical capsule of the prostate, which is nothing but the compressed peripheral glandular tissue of the prostate.

Indications for operation for Benign Prostatic Hyperplasia

  • Prostatism.
  • Acute retention which is unrelieved by passing catheter.
  • Chronic retention.
  • Complications- stone, infection and diverticulum formation.
  • Hemorrhage.

Four main types of Prostatectomy are commonly seen

  1. Supra-pubic prostatectomy.
  2. Retro-pubic prostatectomy.
  3. Trans-urethral prostatectomy.
  4. Perineal prostatectomy.

Supra-pubic prostatectomy

The scientific basis of this operation is that there is a plane of cleavage between the adenomatous part of the gland and the false capsule composed of compressed normal prostate.


It is through this plane of cleavage that the gland is enucleated leaving behind false capsule, which contracts and forms the mucosa above and below.
In this operation, the prostate is approached through the bladder by supra-pubic incision.

Retro-pubic Prostatectomy

In this form of surgery, the position and incision are same as those of the supra-pubic prostatectomy.
Advantages of retro-pubic prostatectomy-

  • The main advantage is that it provides a direct access to the prostatic cavity to enable the surgeon to deal with the hemorrhage effectively.
  • Post-operative bleeding, if it takes place at all, will not be inside the bladder but will be in the retro-pubic space.
    Blood can easily come out from this space through the drainage opening.
  • Probably the most important advantage is its relatively short convalescence period. So the person becomes ambulant quickly.

The only disadvantage of this operative method is that the interior of the bladder is not exposed, so presence of stone, diverticulum’s and neoplasm may be missed. It is always advisable to perform cystoscopy before the surgery.

Trans-urethral Prostatectomy

Indications for this type of surgery are

  • Prostatectomy through this route is indicated when the person presents with urinary obstruction, but there is no gross enlargement of the gland, particularly the lateral lobe.
  • This method is ideal for small fibrous prostate,
  • Middle lobe enlargement,
  • Small adenomatous prostate and
  • Carcinoma.

The resection is carried out under direct vision either by means of a wire loop diathermy or by a circular punch. The instrument is of large caliber and meatotomy or urethral dilatation may be required before the introduction. It is the operation for specialists and the general surgeons hardly venture to perform this operation.

Perineal prostatectomy

This operation has never attained popularity. The operation is performed through a metal bougie which is passed through the urethra.

There are two techniques for Benign prostatic hyperplasia cure that are used frequently now.

Treatment Options For BPH

Laser treatment for BPH

Two new techniques have been used in the treatment.

  1. A non-contact probe method; and
  2. Contact side-firing laser.

In the first method, the probe is used to vaporize the prostatic tissue under direct vision.
In the second method mentioned above, lower energy is used in laser with greater penetration. This causes necrosis of the prostate gland to a varying thickness.

Microwave treatment for BPH

In the first generation machines, the heat produced was between 40 and 45 degree Celsius. But newer machines can provide temperature more than 50 degree Celsius. Microwave is focused within the prostate to destroy prostatic tissue.

 

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