Urology

REVERSIBLE VASECTOMY

It is possible to reverse a vasectomy with microsurgical recanalisation. However, the reversal of a vasectomy can be complicated over time as the deferent ducts are cut off and sealed.

Procedure

There are various techniques depending on the amount of time that has passed since the vasectomy:

• The vasovasostomy
  This procedure is used when the sterilisation was only carried out a few years ago.
  In this case the deferent ducts are reconnected.
• The epididimovasostomy– EV  
  With the passing of time, and due to an obstruction in the epididymis, the surgeon may have to carry out a complex microsurgical technique.
  The epididymis is a cannel which connects the testicles to the deferent ducts. With the passing of time and following a vasectomy this can become blocked. This can measure up to 7 metres and the diametre can be 300 micron.

Type of surgery and anesthesia

This is a microsurgical procedure which lasts between 2 – 3 hours. It involves using sophisticated methods in order to connect and stitch these channels.
Hospitalisation does not generally exceed 24 hours.

Post-operative care

Recuperation should be complete in 10 days.

TURP SURGERY – TRANSURETHRAL RESECTION OF THE PROSTATE

An increase in the volume of the prostate is usually benign, however it creates urination disorders.

Reasons for TURP Surgery:

An adenoma is an increase in volume of the prostate. The increase can be anything between from 30gr right up to 150gr.

The goal of this surgery is to relieve the urethra which is being compressed by the increase in the volume of the prostate.  In this way normal elimination of the urine is restored.

TURP Procedure:

This is normally done through an endo-urological technique (surgery by natural means). This is the most commonly used technique for treating benign prostatic hypertrophy. Currently, the most commonly used technique is with laser. The surgeon inserts an endoscope through the urinary tract, and under visual control, the adenoma is resected, cauterizing it at the same time and then sucking up the resected fragments for pathological analysis (this is done to rule out prostate cancer).
Subsequently a tube is placed in the urethra for a few days so that the tract and bladder can heal properly, and the area can be cleaned with a saline solution.
When the volume of the prostate exceeds 100gr, the technique used is usually the prostatectomy : prostate removal.

Type of surgery and anesthesia:

The TURP surgery takes one hour maximum, depending on the volume of the prostate. It is performed under general or locoregional anesthesia The patient usually remains in hospital for up to 6 days.

Post-operative follow-up of the Transurethral Resection of the Prostate

The patient requires a check up 4 / 6 weeks after surgery.

An annual check-up is recommended.

The basic prostatectomy

The basic prostatectomy is a procedure which surgically removes the internal part of the prostate gland.

Reasons for having the procedure

This is carried out in the case of benign prostatic hiperplasia (BPH) in order to alleviate the urinary symptoms of a non-cancerous condition.
The BPH is a non- cancerous growth in the prostate. It can cause problems with urination as it puts pressure on the uretha.

Procedure

The surgeon makes an incision in the lower part of the addomen, just below the umbilicus in order to reach the prostate. The surgeon only removes the internal part of the prostate gland

Type of surgery and anesthesia

The basic surgery lasts between 1 – 2 hours. This is carried out under general anesthesia, and on occasions using locoregional anesthesia (epidural).

The patient remains in hospital for 3 – 4 days.

Post-operative care

The recuperation takes approximately 5 weeks.

Radical Prostactectomy

Reasons for having the procedure

This is carried out in order to remove all of the prostate gland, as well as some of the adjacent tissues in case of localised cancer.

Procedure

There are various different techniques:

• Radical retro pubic prostactectomy
  The surgeon makes an incision in the lower part of the abdomen, just below the umbilicus, near to the pubic bone. The complete surgery can last between 90 mins – 4 hours.
  The technique is used for the removal of lymphatic ganglions.
•  Radical pereneal prostatectomy
  The surgeon makes an incision in the skin between the anus and the base of the scrotum. (Perineum).
  This surgical procedure is more complicated than the previous one. The small incision makes it difficult to preserve the nerves around the prostate.
  This surgery is shorter than the retro pubic method, and means less bleeding.
• Radical Laparoscopic prostactectomy
  The surgeon makes several small cuts into which he introduces a camera and the necessary surgical instruments to carry out this procedure.
  The advantages of this method of surgery are: less bleeding, less pain, reduced hospitalisation, faster recovery.
• Laparoscopic prostatectomy assisted by robot
  In this case the laparoscopic surgery is carried out using a robotic system.
  The surgeon sits at a control panel near to the operating table and controls the robotic arms in order to carry out the surgery.
  Not all hospitals are able to carry out robotic surgeries.
  The advantages of this type of surgical procedure are the same as those associated with the normal laparoscopic surgery.

Type of surgery and anesthesia

The radical surgery can last between 90 minutes and 4 hours depending on the type of surgery. This is carried out under general anesthesia, and at times using locoregional anesthesia (epidural).

The patient must remain in hospital for 1 – 4 days depending on the surgical technique used.

Post-operative care

The patient can resume normal activities 3 – 5 weeks after the procedure.

The surgery should eliminate all cancerous cells. However, following surgery it is necessary to have regular check-ups, including blood tests to check for the specific prostatic antigene (PSA).