The bladder is the reservoir in which urine from the kidneys is stored before being evacuated during voiding.
The prostate is a gland located below the bladder. To exit the bladder, urine must pass through the prostate, through the urethra.
The urethra is the channel through which urine is evacuated from the bladder.
The increase in prostate volume, linked to prostatic adenoma or benign prostatic hypertrophy (BPH), causes obstruction to the passage of urine. This obstruction may be responsible for difficulty passing urine, or frequent urges to urinate or complications (bladder stones (lithiasis), blood in the urine (hematuria), inability to urinate (urinary retention), and infections of the urogenital system, renal failure, etc.).
Surgical intervention is indicated when drug treatment is no longer sufficient or in the case of complications.
Drug treatment is usually offered as first-line treatment, it can have certain side effects and limited effectiveness.
Surgical intervention is proposed when medical treatment is no longer sufficiently effective or when a complication appears. It consists of removing the adenoma to unclog the urethra (facilitate the passage of urine).
Surgical alternatives are endoscopic, transurethral resection of the prostate (with or without laser).
The other alternatives, particularly in the event of urinary retention with the inability to urinate, would be either to permanently leave a bladder catheter which will be changed regularly by a nurse, or to carry out catheters several times a day, to be done by yourself or by a nurse.
Your surgeon has explained to you why, in your case, he favors treatment by adenomectomy rather than another type of intervention. The volume of the prostate is one of the important selection criteria.
The procedure offered to you is called adenomectomy.
It consists of removing the prostate adenoma which obstructs the urethra. This intervention is not done naturally (passing through the urethra) but by opening the abdomen (open or laparoscopic surgery).
The procedure requires hospitalization.
Any surgical procedure requires preparation which may vary depending on each individual. It is essential that you follow the recommendations given to you by your urologist and your anesthesiologist. If these recommendations are not followed, the intervention could be postponed.
A bladder and prostate ultrasound can be performed to measure the volume of the prostate and assess the ability to empty your bladder.
You must tell your urologist and during the anesthesia consultation if you are taking treatment to thin the blood (anti-platelet aggregation, anticoagulant).
It could be modified before the intervention.
A urine analysis is prescribed before the procedure to check sterility and treat a possible infection. An untreated urinary infection leads to delaying the date of your operation.
An antibiotic (antibioprophylaxis) will be administered to you systematically during the procedure following the protocol established in the establishment.
This procedure is performed under general or loco-regional anesthesia.
Surgical prostatic adenomectomy consists of removing the adenoma, that is to say the central part of the prostate, passing through the bladder or directly by incision in the prostate capsule. The peripheral prostate is left in place.
It can be performed by opening the abdomen through an incision of a few centimeters or laparoscopically.
In the transvesical technique, the bladder, located under the muscular wall of the abdomen, is opened. The surgeon dissects the adenoma and separates it from the rest of the prostate through the bladder. The surgical specimen is systematically analyzed by the pathologist to confirm that it is a benign lesion.
At the end of the procedure, a drain is most often placed in the operating area. A bladder catheter, placed during the procedure, is maintained for several days following the recommendations of your urologist. It can help wash the bladder to prevent the formation of blood clots and blockage of the catheter.
If a drain has been placed, it is removed after a few days. If a so-called “cerclage” wire has been placed to reduce bleeding, it is removed by simple traction through the skin 1 or 2 after the procedure.
The time frame for stopping bladder washing and removing the catheter varies, usually a few days, and is decided on a case-by-case basis by your surgeon. When blood clots obstruct the catheter, bladder washing with a large-tipped syringe is used to restore catheter patency.
The bladder catheter causes irritation of the urethral canal which can manifest itself as burning or spasms (painful urge to urinate despite the catheter). Appropriate drug treatment is prescribed if necessary.
Anticoagulant treatment is prescribed postoperatively to prevent the risk of phlebitis.
Skin stitches or staples are removed within 6 to 12 days.
Home nursing care includes care of the skin scar as well as daily injection of anticoagulant. It is recommended that you drink plenty of fluids to wash the bladder and prevent the urine from turning red. Clot formation can cause blockage of urine.
You are also advised to avoid significant physical activities in the month following the procedure.
Sexual intercourse is not recommended immediately following the procedure. In the majority of cases, there is no deterioration in the quality of the erection but the disappearance of ejaculations is almost systematic. This is characterized by the absence of emission of semen at the time of orgasm. This does not in principle modify the sensation of pleasure, neither yours nor that of your partner. However, it is essential to explain the situation to your partner before resuming sexual activity to avoid any negative reactions. Libido is usually not changed by the intervention.
To avoid pain, analgesic treatment may be prescribed for a few days.
Improvement in urinary symptoms may be gradual over the first few months.
During this time, you may experience urgent urges, bladder leakage, or burning while urinating.
Prescriptions can be given to you for additional examinations to be carried out before the follow-up consultation. A letter is sent to your attending physician to keep him informed of your state of health.
The postoperative consultation takes place in the weeks following the operation. Follow-up consists of assessing the improvement in your urinary symptoms and the good quality of your bladder emptying. A urine analysis to look for an infection and an ultrasound with measurement of post-void residue may be prescribed.
Follow-up is then usually carried out once a year by the patient’s urologist or treating physician. Several years after the operation, there may be regrowth of prostate tissue which may lead to a recurrence of symptoms.
If prostate cancer is diagnosed on the prostate tissue removed during the procedure, your urologist will specify the conditions for follow-up or treatment.
Prostate cancer can occur remotely in the remaining prostate, without this being linked to the intervention.
Post-operative fever
The occurrence of fever after prostatic adenomectomy is not usual. Any unexplained post-operative fever should lead to a medical consultation.
Healing
Abdominal surgery involves one or more incisions of varying size. These incisions are not only areas of weakness, but also possible entry points for infection. It is therefore necessary to ensure good local hygiene. If the scar becomes red, hot or if it is raised, it is important to show this scar to your surgeon without urgency: it may be a hematoma or an abscess.
The skin heals over several days. During this period, a little bleeding may occur which can be stopped by compressing it using a compress or a clean cloth. The removal of the wires or staples is carried out by a nurse following the medical discharge prescription.
Disunion of the skin can sometimes occur. If this opening is superficial, you simply have to wait for it to close; the closure time can reach several weeks (especially in diabetic patients or those on corticosteroid treatment). On the other hand, in the event of a feeling of deep cracking or deep disunity, it is necessary to consult your surgeon quickly.
Tobacco and malnutrition slow down healing. So remember to stop smoking and eat well. Avoid any direct sun exposure to your scars which risks making them unsightly.
Food
After your procedure, drink more for a few days. This helps remove debris or blood that may accumulate following the procedure and reduces the risk of infection.
There are no particular dietary restrictions following this procedure.
SIGNS THAT MAY OCCUR AND WHAT TO DO
Pain in the wound or abdomen
You have been prescribed pain medication. Severe or persistent pain requires you to contact your doctor. Discharge or hematoma from the wound most often heals with local care.
Urinary symptoms
The area that was treated often requires several days to heal. During this period, you may experience irritation or burning in the urinary canal when you urinate. You may also have urgent or more frequent urges to urinate, including at night. Most often, these symptoms are minor to moderate, gradually diminish over time and do not require special treatment. If your urinary symptoms worsen or do not improve, difficulty urinating, if the urine becomes cloudy or smelly or if you develop fever, abdominal, lower back or genital pain, contact your doctor or your doctor. urologist.
Clear discharge (urine) from the scar
All of these signs may correspond to urine leaking from the surgical site. This situation is rare, but requires a rapid consultation with your urologist so that he can improve the drainage of your bladder.
Bladder catheter
In some cases, a bladder catheter may be left in place for a few days after you return home. The nurse or doctor will show you how to empty the urine bag and how to care for the catheter. You will receive a specific document from your urologist. Bladder pain and spasms are possible, these are linked to irritation of the bladder by the probe.
These symptoms are most generally short-lived and can recur regularly. Contact your doctor or urologist if discomfort persists.
Urinalysis
You may have been asked for a urinalysis (ECBU). After an adenomectomy, most often there is leukocyturia (presence of very numerous leukocytes) and hematuria (red blood cells in the urine). These two anomalies are usual and indicate ongoing healing. No antibiotics are necessary if there are not enough germs.
▪ How can I wash myself?
You will be able to take showers (avoid spraying directly on the scar) as soon as you leave and bathes at your convenience 15 days after the procedure.
▪ When can I return to my usual physical activities?
A fortnight after the procedure and if the urine is clear, you can gradually resume your physical activities.
▪ Can I do sports?
You will have to wait for the post-operative consultation one month after surgery to consider gradually resuming your sporting activities.
▪ Can I drive after the procedure?
Certain pain medications can cause drowsiness which is sometimes not compatible with driving.
▪ Can I travel?
Unless otherwise advised by your doctor, travel is possible.
In the majority of cases, the intervention offered to you takes place without complications. However, any surgical procedure carries a certain number of risks and complications described below.
Some complications are linked to your general condition.
Any surgical procedure requires anesthesia, whether local-regional or general, which carries risks. They will be explained to you during the pre-operative consultation with the anesthesiologist.
Other complications directly related to the intervention are rare, but possible.
COMPLICATIONS COMMON TO ALL SURGERY ARE:
▪ Local, generalized infection
▪ Bleeding with possible hematoma and sometimes transfusion
▪ Phlebitis and pulmonary embolism
▪ Allergy
THE COMPLICATIONS SPECIFIC TO THE INTERVENTION ARE IN ORDER OF FREQUENCY:
▪ Bleeding during the procedure can be significant, leading to anemia which may require a blood transfusion during or after the procedure.
▪ There may be a reappearance of bleeding in the urine during the first month (also called bedsores) requiring, depending on the severity: good hydration, the installation of a bladder catheter or even hospitalization. Rarely, reoperation may be necessary to remove blood clots in the bladder.
▪ Urinary retention (inability to urinate) is a possible complication. In the early post-operative period, it may be due to the presence of clots secondary to a resumption of bleeding (fall of bedsores). A bladder catheter is placed for a few days if urinary retention due to clots occurs.
▪ Urinary infection can lead your urologist to prescribe antibiotic treatment and check that your bladder is emptying correctly. If you have a fever or urinary burning, do not hesitate to contact your doctor or urologist quickly.
▪ The skin scar can become infected (abscess). If there is pain in the scar, redness or discharge of pus, you should contact your surgeon.
▪ Rarely, a flow of urine through the scar (vesicocutaneous fistula) may appear, it may require resting the probe for several days.
▪ Erectile dysfunction is rare after this procedure but possible.
▪ Urinary incontinence is rare, most often transient
▪ In rare cases, secondary narrowing of the urethral canal or bladder neck may occur, which may require re-intervention.
▪ Rarely, a disunion of the abdominal wall (incisional hernia) may occur, leading to a bulging at the level of the scar.
▪ Exceptional complications may arise and require re-intervention:
-Digestive wounds
-Pelvic abscess
-Urinary fistula
-Evisceration (exit of the intestine through the scar)
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