Лазерная энуклеация аденомы простаты одна из разновидностей хирургического лечения доброкачественной гиперплазии предстательной железы. Данная методика позволяет удалять аденому предстательной железы даже больших размеров с минимальными побочными эффектами и осложнениями.

During laser enucleation of prostate adenoma, a holmium laser is used, which has found wide application in urology, not only for removing the prostate gland.

Holmium laser has been used to treat benign prostatic hyperplasia for over a decade. But over the past five years thanks to improved technology and equipment, there was a significant expansion of the range of possibilities for the treatment of benign prostatic hyperplasia from simple vaporization to complete removal, or rather enucleation of prostate adenoma.

Picture.Laser device used for laser enucleation of prostate adenoma and other laser operations.

Currently laser enucleation in combination with morcellation (morcellation - division into fragments) makes it possible to remove large adenomas (more than 100 cm3), which in turn avoids open adenomectomy.

What happens during laser enucleation of prostate adenoma?

Laser enucleation of prostate adenoma performed by transurethral (through the urethra) access. Оптическое оснащение эндоскопа позволяет хирургу видеть все, что происходит во время операции. Через дополнительный порт в эндоскопе к аденоме подводится лазер, с помощью которого производится ее энуклеация.

Enucleation implies the removal of the lobes of the prostate gland without violating the integrity of the capsule. Laser operation основана на эффекте нагревания тканей, поэтому во время процедуры происходит постоянное орошение операционного поля для его охлаждения. После того как доли простаты отделены, с помощью специального инструмента хирург разделяет их на фрагменты для более удобного извлечения. После операции требуется catheter insertion into the bladder. The day after the operation, it is removed.

Average duration laser enucleation of prostate adenoma takes 60-120 minutes.

After laser enucleation, the resulting fragments are sent for examination under a microscope for excluding prostate cancer.

The postoperative period does not differ from those in other surgical interventions, you can read about this in the article "After removal of adenomas are simple."

Picture. Laser enucleation and transurethral resection of prostate adenoma.

Complications of laser enucleation of prostate adenoma

Frequent (more than one case per ten interventions):

• Temporary moderate burning, bleeding (blood in the urine) or increased urination;
• In 75%, after complete enucleation of the prostate, such a phenomenon may develop as “dry orgasm"- during ejaculation, semen enters the bladder.
• Weak erection (impotence can develop in 14% of cases);
• Infections genitourinary system;
• In case of incomplete removal of prostate adenoma in 10% of cases, it is required re-treatment a few years after the first operation;
• Temporary urinary incontinence occurs in 10-15% of cases and, as a rule, disappears 3-6 weeks after laser enucleation of prostate adenoma;

Infrequent (develop in 1 in 50 cases):

• Damage to the urethra with its subsequent narrowing;
• Necessity catheter insertion into the bladder to drain urine (if the bladder is weak);

Rare (less than 1 case per 100 operations):

• Prostate cancer detection in deleted fragments, which requires more serious treatment;
• Residual fragments prostate adenomas in the bladder not removed during surgery, which requires a procedure to remove them;
• Long-lasting disorder of urination (in 1-2% of cases);
• It is extremely rare that a complication such as bladder damage.

Benefits of laser enucleation of prostate adenoma

• There is no limit to the size of the prostate gland for this treatment. Can be removed by laser enucleation iron up to 200 grams and more.
• The operation is suitable for patients with blood clotting disorder, as the laser action causes parallel "sealing" of the vessels, which prevents excessive bleeding;
• Laser enucleation of prostate adenoma is not accompanied by the development TUR syndrome, since during the operation, balanced aqueous solutions are used to cool the operating field, in contrast to monopolar transurethral resection of prostate adenoma;
• During the operation there is no complete destruction of tissues the prostate gland, which allows microscopic examination of fragments to exclude prostate cancer;
• Required after surgery short catheter retention period in the bladder (less than 24 hours);
• More short hospital stay and recovery after surgery.

Disadvantages of laser enucleation of prostate adenoma:

• Relatively high cost of the operation, which is mainly determined by expensive equipment;
• Technical complexity performing an operation that requires good surgeon skills;
• Relatively long-term surgical intervention: On average, the rate of removal of prostate tissue is 1 gram per minute.

Laser enucleation of prostate adenoma - reliable, effective and patient-tolerated surgical technique лечения доброкачественной гиперплазии предстательной железы. Она ассоциирована с минимальными побочными эффектами и коротким периодом госпитализации и восстановления.