Adenoma 50–60 g: features of resection
As the volume of the gland increases, the resection time and the volume of tissue removed increase, so for adenomas of 50–60 cm³, bipolar equipment operating in saline solution is important: it allows you to operate longer without the risk of TUR syndrome and coagulates vessels better. The surgeon removes tissue in sectors, carefully treating the area of the bladder neck and apex, where residual tissue often remains. With this volume, TUR and HoLEP give comparable results; HoLEP is preferred when taking anticoagulants. The cost according to the clinic’s price list is higher than for iron up to 50 g, due to the duration of the operation.
Indications for prostate tour
- prostate adenoma (BPH) with severe urination problems that are not amenable to drug treatment;
- residual urine more than 100–150 ml, history of acute urinary retention;
- recurrent urinary tract infections, bladder stones, blood in the urine due to adenoma;
- beginning expansion of the kidneys (hydronephrosis) due to impaired outflow;
- prostate volume up to 75–80 cm³ (with a larger volume - HoLEP or adenomectomy);
- palliative TUR for prostate cancer to restore urine outflow.
How is the operation performed?
TUR is performed under spinal anesthesia - the patient is conscious, but does not feel the lower half of the body; General anesthesia is used according to indications. A resectoscope, a thin instrument with a video camera and an electrical loop, is inserted through the urethra. Under the control of the image on the monitor, the surgeon cuts off the adenoma tissue, which compresses the urethra, layer by layer, down to the surgical capsule of the gland, while simultaneously coagulating the vessels. Small fragments are washed out of the bladder and completely sent for histology - this allows cancer to be excluded.
At the end of the operation, a catheter with a flushing system is installed in the bladder for 1–3 days. The operation lasts 60–90 minutes depending on the volume of the gland. Modern bipolar resectoscopes operate in saline solution, which makes TUR safe even for large adenomas and in patients with concomitant diseases.
Preparing for surgery
The examination includes PSA (if elevated, a biopsy before surgery), TRUS with measurement of prostate volume and residual urine, uroflowmetry, general and biochemical blood tests, coagulogram, urine analysis and culture (infection is treated in advance), ECG, and, if necessary, consultation with a cardiologist and anesthesiologist. Blood thinners should be discontinued 5-7 days in advance in consultation with the doctor. Hospitalization the day before or the morning of surgery, 8 hours on an empty stomach.
Recovery after TOUR
The patient spends 2–3 days in the hospital: the catheter is removed after the urine becomes clear. In the first 2-3 weeks, frequent urges, burning and blood in the urine are possible - this is normal while the adenoma bed heals. It is recommended to drink 2–2.5 liters of water, avoid constipation, heavy exercise, cycling, alcohol and spicy foods. Work - in 1-2 weeks, full recovery - 4-6 weeks. Sexual activity is resumed after 4 weeks; Some patients experience retrograde ejaculation after TUR (semen enters the bladder) - this is safe and does not affect erection.
TUR, HoLEP or open adenomectomy
TUR is a proven standard for prostates up to 75–80 cm³. HoLEP (laser enucleation) removes an adenoma of any size with less blood loss and a shorter catheterization period, but requires a special laser and surgeon experience. Open (transvesical) adenomectomy is rarely used today - for giant adenomas and the impossibility of endoscopy. All three methods are available in the clinics below; The urologist chooses the operation based on the volume of the gland, concomitant diseases and examination results.
Prostate TOUR in Tashkent: where to do it
In the clinics presented on the page, TUR of the prostate is performed by urologists with extensive endoscopic experience using bipolar equipment, with histological examination and hospital observation. Prices in the price list are divided by gland volume (up to 50, 50–60, 60–75 g) and include histology; anesthesia and bed days are paid according to the price list. Sign up for a consultation - the doctor will determine the indications and method of surgery.
