Prostate Enlargement: When to operate?

The article was expertly consulted by MSc Tran Thanh Hung - Department of General Surgery - Vinmec Ha Long International General Hospital.

Prostate enlargement is a common condition in men aged 50 and over. The disease is often accompanied by cardiovascular disease, respiratory disease, diabetes.... That raises many concerns for patients: Will prostatitis go away on its own and when should prostate surgery be performed?

The prostate gland is a small gland, about 10-20g in size and found only in men. The prostate gland is located below the bladder neck, wrapping around the urethra at the point where it joins the bladder neck. When this gland is enlarged due to a certain cause (for example, infection, cancer...), it will lead to narrowing and blockage of the urethral lumen due to compression, causing abnormal manifestations when men go. urination. If this condition is prolonged, late treatment will adversely affect the bladder, kidneys, sexual function and be life-threatening.
Characteristic manifestations of prostate disease: Difficulty urinating, urinary frequency, urinary retention. Other manifestations: after urinating, you do not feel comfortable but still feel the urge to urinate, you may urinate blood, and you have a urinary tract infection. These manifestations progress slowly, most patients will gradually adapt and be difficult to recognize. Manifestations of the disease are not proportional to tumor size.

After the patient is examined, performed tests and diagnoses, the doctor will make a conclusion whether to treat medically or to have surgery for prostate enlargement. Today, there are many drugs that help improve the urinary disorders of patients with prostate enlargement, as well as many different surgical interventions. In general, depending on the patient's condition, the size of the tumor and whether this tumor causes any complications on the urinary tract or not... the doctor will choose the appropriate treatment.
Medical treatment with drugs and long-term follow-up is the general trend in the treatment of prostate enlargement today, only when medical treatment fails or has cancer complications, the doctor will order Prostate surgery problem.

Surgery for prostatic hypertrophy is indicated when the fibroid tumor has caused complications or when medical treatment has failed. There are many methods of surgery for prostate enlargement, but mainly laparoscopic ablation through the urethra or fibroid surgery through the abdomen.
Currently, at Vinmec International General Hospital, a number of surgical methods for prostate enlargement are applied, including:

Indicated subjects:
Patients with prostate enlargement (usually from 25 to 250 grams). The patient had an enlarged prostate gland with bladder stones. Patients with urological ultrasonography have residual urine in the bladder greater than 100ml. Patients with acute urinary symptoms accompanied by renal failure, blood test creatinine increased. There are urinary disorders (nocturia, urinary frequency, urinary incontinence) affecting the quality of life. Expect to be treated surgically to improve quality of life. Advantages of the technique: Advantages of Bipolar knife laparoscopic prostatectomy: Less bleeding, less pain; Short hospital stay (50% of patients can be discharged on the same day after treatment; 40% can stay in the hospital for 1-2 days); There is no need to place a bladder drain after the treatment.

Process: Clinical examination of the prostate gland through the rectum and consultation with a urologist, (providing information according to the urinary disorder test questionnaire - IPSS) to determine the extent affect the symptoms of prostate enlargement and determine whether the patient has an indication for surgery or not? Take prophylactic antibiotics for patients before and after surgery Do necessary functional investigations (PSA blood test, urogram, urinary ultrasound, urine culture test) Prepare surgical records surgery, pre-anaesthesia The patient is anesthetized during surgery. Surgery usually lasts 1 hour.

Indicated subjects: Patients with prostate enlargement with complications of complete urinary retention, even after urethral catheterization. Incomplete urinary retention with residual urine after urinating, failed internal therapy Recurrent hematuria due to prostatic hypertrophy Bladder diverticulum, bladder stones due to prostatic hypertrophy Recurrent urinary tract infection Renal failure (renal failure should be completely treated before endoscopic resection). Advantages of surgery: The patient has no incision, good psychological and aesthetic feeling. Post-surgery is gentle due to less pain, quickly regains movement, thus avoiding complications due to long lying down, short hospital stay, patients quickly urinating in a natural way. The technique is similar to the transurethral ablation technique, safe because the risk of bleeding and perforation is very low, the cost is low because there is almost no need for continuous rinsing after surgery. Using isotonic saline solution As a substitute for hypotonic lavage solution, the risk of endoscopic syndrome is eliminated. No electric current flows through the patient's body, reducing the risk of electrical burns, urethral stricture or bladder neck fibrosis after surgery. Good hemostasis, reduced urinary circulation and short hospital stay Using 0.9% sodium chloride solution without ions (Glycine or Mannitol) should not worry about passive absorption of hypotonic fluid into the body No An electric current (such as a unipolar knife) flows through the patient's body, reducing the risk of electrical burns at the contact site with the electrode plate, reducing the danger for patients with pacemakers. Procedure: Procedure: Patients come to the pre-operative examination -> examine and test -> have indications for surgery and are eligible for surgery -> admitted to the surgical department -> prepare for surgery -> surgery surgery -> follow-up and post-operative care -> eligible for hospital discharge -> discharge.

Indicated subjects: Patients with complete urinary retention, even after urethral catheterization. Incomplete urinary retention with residual urine after urinating, failure of medical treatment. Recurrent hematuria due to prostatic hypertrophy Bladder diverticulum, bladder stones due to prostatic hypertrophy Recurrent bacteriuria. Prostate enlargement affects health, sleep or interferes with work. Advantages of the technique: Laser ablation surgery for prostatic hypertrophy is a technique developed on the basis of transurethral prostatectomy with a unipolar, bipolar knife, which is already a minimally invasive technique. invasive, natural route, alternative to open surgery to remove prostate tumor with many complications, more invasive in patients who are usually elderly. With the coagulation and evaporation heat of the laser, the surgical process of prostate tumor is better hemostasis, less bleeding, faster recovery, and reduced risk of bladder neck stenosis, post-operative sphincter disorders. The patient can withdraw the catheter after 1 day, discharged from the hospital after 2-3 days. Procedure: Patients come for pre-operative examination -> examination and testing -> have indications for surgery and are eligible for surgery -> admission to surgical department -> preparation for surgery -> surgery -> follow-up and post-operative care -> eligible for discharge -> discharge

Team of experienced doctors, well versed in each surgical step. Modern equipment, high efficiency in treatment
Modern flexible endoscope system: C-Am system, intraoperative ultrasound machine helps to clearly locate the position and size of the stone help the surgical hospital monitor the condition of the stone during and after surgery so that it can bring the best lithotripsy results to limit complications during and after surgery
Professional services: Modern civilized disease prevention system, caring Comprehensive care, meals, rest, exercise, health education, each room is equipped with amenities like a 5-star hotel apartment, patient information is confidential
Hybrid operating room is The most modern operating room system in the world today, integrating the operating room and advanced imaging equipment (CT scan, MRI, ultrasound...) helps to reduce surgery time and bring more efficiency. the best surgical outcome for the patient.
In general anesthesia, Vinmec adheres to anesthesia protocols, anesthesia safety guidelines, anesthesia checklists for 100% of surgeries to minimize incidents and unwanted effects.