The proposed intervention aims to surgically treat prostate adenoma endoscopically without the use of a laser.
The bladder is the reservoir in which urine from the kidneys is stored before being released during urination (urinating).
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 expelled 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).
The surgical alternatives are either endoscopic, i.e. transurethral resection of the prostate with or without laser, or by open or laparoscopic surgical route.
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. These options can be considered if temporary or definitive surgical intervention is not possible.
Your surgeon has explained to you why, in your case, he favors treatment by endoscopic resection rather than another type of intervention.
The procedure offered to you is called prostate resection. It can be carried out using different techniques (resection, enucleation, vaporization).
This treatment is carried out using a natural, trans-urethral route. It consists of widening the urethral canal by removing the prostate adenoma that surrounds it. The procedure requires hospitalization (which can be carried out on an outpatient basis in certain cases).
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. Please report any possible allergy to antibiotics.
This procedure is performed under general or loco-regional anesthesia.
The surgeon inserts a device called an endoscope into the urethral canal which allows him to see into the canal and locate the prostate. A resector allows the prostate to be cut into shavings or the prostate to be vaporized depending on the chosen technique. Unless vaporized, the removed pieces of prostate are sent to the laboratory for analysis.>
During the procedure, an electrical insulating liquid is used.
A bladder catheter with washing is placed at the end of the procedure.
The bladder catheter can be maintained for one to several days following the recommendations of your urologist. It can help flush the bladder to prevent blood clots from forming. When the urine coming out through the catheter becomes clear enough, washing can be stopped.
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.
You are recommended to drink plenty of fluids to limit bleeding in the urine (hematuria). Typically, bleeding in the urine may be present for several days to a few weeks after the procedure.
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. The quality of erections and libido are usually not modified by the intervention.
In certain cases, anticoagulant treatment may be prescribed or reintroduced postoperatively to prevent the risk of phlebitis. Home nursing care includes daily injection of anticoagulant, if prescribed.
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 an urgent urge or burning while urinating.
Paradoxically, temporarily you may be more embarrassed.
Prescriptions may 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.
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 a urinary tract infection. You should drink about 2 liters of water per day (about 10 glasses) and sometimes more if the urine does not clear. On the other hand, there is no need to drink more if your urine has turned light yellow.
There are no particular dietary restrictions following this procedure.
The area that was operated on often requires several weeks to heal. During this period, you may experience irritation or burning of the urinary canal when urinating. You may also experience urgent or more frequent urges to urinate, including at night. Most often, these symptoms are minor to moderate, they gradually diminish over time and do not require special treatment.
If your urinary symptoms worsen or do not improve:
It is common to have some blood in the urine, especially at the beginning of urination. The presence of blood may persist or reappear up to 4 weeks after the procedure. This is a common process during healing. Drink heavily and regularly so that the urine clears, then enough to keep the urine a pale yellow color.
If you have significant bleeding or if you are no longer able to urinate due to clotting (blood clot in the urine), contact your doctor or urologist. In case of urinary retention (inability to urinate), go to the nearest emergency department.
A urinalysis (ECBU) is sometimes requested depending on your post-operative symptoms. After endoscopic resection of the prostate, 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.
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.
Prostate monitoring 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. Prostate cancer can occur remotely in the remaining prostate, without this being linked to the intervention.
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.
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