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Prostate Surgery

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A prostate is a small, squishy gland, about the size of a walnut that sits right underneath your bladder and in front of the rectum. It’s a sexual gland that aids in secretion during intercourse. As a part of the male reproductive system, it serves to produce fluid that transports and defends the sperm. The prostate gland surrounds the urethra, through which urine leaves the body.An enlarged prostate indicates that the gland has expanded and grown in size.

Almost all men experience enlargement ofthe prostate as they age, and any enlargement might cause problems with the passage of urine.The size of the gland increases, causing frequent urination, stopping and starting again while urinating, blood in urine, or the urge to urinate frequentlyat night.These are some of the symptoms that affect urination.



Courtesy: Urology Specialist

Prostatectomy

A prostatectomy is a surgical operation that includes removing part or all of the prostate gland. Usually, this is carried out to treat benign disorders like localized prostate canceror other pelvic cancers.Depending on the type of treatment necessary, there are mainly two kinds of prostatectomy and a few subcategories.

  1. Simple Prostatectomy:A prostate gland consists of two parts: inner and outer.An inner section of your prostate gland enlarges with age and an outside part forms a capsule that makes up the prostate gland.In a simple prostatectomy, the inner piece of your prostate is removed through a vertical cut (incision) made in the lower abdomen while leaving the outer portion intact. So, surgically removing the swollen prostate from its capsule is known as a simple prostatectomy. The nerves and muscles of the sphincter are unharmed. It is used to treat benign disorders like benign prostatic hyperplasia (BPH), which causes the prostate to grow.


Courtesy: TebMedTourism

  1. Radical Prostatectomy: A radical prostatectomy is a surgical procedure in which a surgeon removes the entire prostate gland including surrounding tissues like seminal vesicles, and accompanyingpelvic lymph nodes. It is one of the methods of treatment for men with locally advanced prostate cancer.

There are two types of radical prostatectomy—Retropubic and Perineal Prostatectomy.

  • An abdominal wall incision is used to remove the prostate gland during a retropubic prostatectomy (RRP).


Courtesy: National Cancer Institute (NCI)

  • An incision is made in the perineum, an area between the scrotum and the anus during a perineal prostatectomy, which involves the removal of the prostate.

Men who have localized prostate cancer typically receive this treatment, which includes a variety of widely utilized methods, including:

  1. Open Radical Prostatectomy: It is a surgery meant to completely remove the prostate and portions of the surrounding tissue, such as the seminal vesicles (a gland that aids in the production of semen).It can also be necessary to remove the lymph nodes. An incision (cut) is made in the lower abdominal wall or in the perineum (the region between the scrotum and anus) during an open radical prostatectomy. However, there’s a conscious measure which is taken to keep the nerves that regulate penile erection and the bladder unharmed.
  2. Laparoscopic Radical Prostatectomy:Laparoscopic Radical Prostatectomy is a surgical treatment which is the least invasive and is used to remove a patient’s cancerous prostate. In contrast to conventional open surgery, laparoscopic surgery uses five tiny incisions rather than one, large one. As a result, there is less abdominal trauma, greater cosmetic results, and often quicker recovery.In comparison to open surgery, this procedure is less invasive.
  • Robotic-assisted Radical Prostatectomy: In robot-assisted radical prostatectomy, the prostate is removed using tiny incisions in the lower abdomen, just like in the case of laparoscopic radical prostatectomy. Through the incisions, a surgeon inserts and controls robotically assisted equipment. This makes the surgeon’s hand movements much more precise, making the surgery even less invasive as a whole.Robotic-assisted surgery has a number of advantages over conventional open surgery, including less blood loss, a shorter hospital stay, and better postoperative urine controland erectile function.

Transurethral Resection of the Prostate (TURP)

Another procedure to treat BPH (benign prostatic hyperplasia) symptoms is transurethral resection of the prostate (TURP), which is a surgical procedure in which a portion of the prostate is removed. A tool called a resectoscope, which is a narrow metal tube with a light, camera, and loop of wire, is used to do TURP. No cuts (incisions) need to be made in the skin because this is passed through the urethra and into the prostate.

Part of the prostate is removed with a resectoscope.


Courtesy: European Association of Urology (EAU)

In place of a laser, a resectoscope is inserted into the urethra during the procedure to view the prostate tissue and bladder lining. A heated loop of wire is employed to cut away the part of the prostate that is causing symptoms to the patient by heating it with an electric current. After that, a catheter—a flexible, thin tube—is inserted into the urethra to pump fluids into your bladder and flush out the excised prostate tissue.General anesthesia is performed during the procedure so that the patient does not endure any pain while the procedure is being carried out. The whole surgery can usually last up to an hour depending on how much prostate needs to be removed.Until the urethra heals and the patient can urinate on his own, the catheter will be needed for 1-3 days.

Pelvic Lymphadenectomy

It is a surgery carried out to remove pelvic lymph nodes so they can be examined under a microscope to check for cancer.This typically occurs prior to a radical prostatectomy to determine whether additional, invasive surgery is required.The pelvic lymph nodes are surgically removed. A biopsy is done on a few of the nodes to look for any cancerous cells, which would be an indication that prostate cancer has started to spread to nearby tissues.If a biopsy reveals lymph node cancer, a radical prostatectomy may have serious side effects without stopping the progression of the cancer. Different treatments could be suggested by a cancer specialist.

Conclusion

A multidisciplinary team approach is necessary for the management of prostate cancer. Identification of various risk factors is important for tailoring the treatment of localized prostate cancer. It is of paramount importance to have risk adopted treatment approach.  Surgical techniques that have been improved will provide more effective prostate cancer control while reducing related morbidity.The adoption of screening programs more widely is also aiding in early detection. More precise preoperative staging will be possible thanks to improvements in tumour markers, imaging, and biopsy procedures.These, together with advancements in prognostic markers, assist both the doctor and the patient in determining the acceptability of treatment alternatives with better result estimation.

Understanding the molecular processes that underlie carcinogenesis will likely result in the most significant advancements in the treatment of prostate cancer. There is tremendous potential for the creation of diagnostic and treatment tools. It is possible to examine the effectiveness of a certain course of treatment at the molecular level and to build plans for halting or delaying the growth of cancer.

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