Progress of the operation
Under spinal or general anesthesia, an incision of 8–10 cm is made above the pubis, and the anterior wall of the bladder is opened. Through its neck, the surgeon uses his finger to peel off the adenoma from the surgical capsule of the prostate and removes it as a single block - given its gigantic size, this is faster and more reliable than any crushing. The adenoma bed is sutured to stop bleeding; if there are accompanying stones or diverticulum, they are removed in the same operation. A urethral catheter and suprapubic drainage are installed, and the bladder wall and wound are sutured. The removed tissue is sent for histology.
When is an open adenomectomy performed?
- prostate adenoma with a volume of more than 100–150 cm³ when HoLEP is not available;
- combination of adenoma with large stones or bladder diverticulum requiring open surgery;
- impossibility of transurethral access: urethral stricture, ankylosis of the hip joints;
- inguinal hernia, which is planned to be repaired simultaneously.
Adenomectomy, TUR and HoLEP
Open surgery was the standard for large adenomas before the advent of laser enucleation: it reliably removes all tissue, but is associated with an incision, blood loss, 7-10 days of hospitalization and 6-8 weeks of recovery. Today, with the availability of HoLEP, the same volume is removed through the urethra with a catheter for 1 day. TUR is limited to a volume of 75–80 cm³. Open adenomectomy is reserved for cases where endoscopy is not possible or another open operation is needed at the same time.
Recovery
In the hospital - 7-10 days: drains and catheter are removed as the bladder and adenoma bed heal. Urination is free after removal of the catheter; In the first weeks, frequent urges are possible. The sutures are removed on the 10th–12th day. Physical activity is limited to 6–8 weeks. The result is lasting: the adenoma is completely removed, repeated operations are required in less than 2% of cases. As after endoscopic operations, retrograde ejaculation is characteristic; the erection remains.
