Operace prostaty

18.3.2012 , Vladislava Králová

prostata-operace.jpg - kopie
prostata-operace.jpg - kopie
K operaci prostaty při jejím nenádorovém zvětšení přistupujeme, pokud jsme dostatečně neuspěli s konzervativními metodami, nebo při výskytu komplikací. U nádoru prostaty volíme operaci v případě, že je nádor lokalizován pouze na žlázu, nejsou postiženy svodné mízní uzliny a nevyskytují se ani metastázy. Jaké jsou nejčastější operační výkony a který z nich je výhodnější?

Operace prostaty

Prostata neboli předstojná žláza je orgán uložený v malé pánvi pod močovým měchýřem, jejím středem prochází močová trubice. Hlavní funkcí je tvorba prostatického sekretu, který je významnou součástí ejakulátu, umožňuje totiž lepší pohyb spermií a jejich delší přežívání. K operaci prostaty přistupujeme nejčastěji při nenádorovém zvětšení prostaty a u nádoru prostaty, kdy je totiž operace jediným možným řešením.

Léčba nádoru prostaty

Operaci prostaty při jejím nenádorovém zvětšení volíme tehdy, pokud jsme dostatečně neuspěli s konzervativními metodami nebo pokud se vyskytují komplikace jako zástava odtoku moči nereagující na jinou léčbu, opakovaně se vyskytující krev v moči, ledvinová nedostatečnost atd. U nádoru prostaty je operace volena, pokud je nádor lokalizován pouze na žlázu a nejsou postiženy svodné mízní uzliny či založeny vzdálené metastázy. Existuje řada výkonů, základní jsou ale dva. Jde o tzv. transuretrální resekci prostaty a otevřenou prostatektomii. Díky četnému výskytu zvětšené prostaty jsou hledány další možnosti, označují se společně jako miniinvazivní metody. Jako příklad miniinvazivní operace prostaty lze uvést vložení balónku do té části močové trubice, která prochází prostatou, a její rozšíření. Mezi další patří termoterapie nebo zavedení endoprotéz do prostaty, které zajišťují drenáž a další.

Operace prostaty transuretrální resekcí

Jde o metodu operace prostaty, kdy je prostata odstraněna pomocí endoskopického nástroje, který je zaveden do močové trubice. Jsou postupně pomocí kličky (která představuje vysokofrekvenční elektrodu) nebo pomocí laseru odstraňovány malé části prostaty, které jsou vyplachovány ven z močového měchýře. Je důležité materiál odeslat na histologický rozbor. Při operaci prostaty je nutné stavit krvácení. Po zákroku je do dutiny, která vznikla odebráním prostaty, zavedena balónková cévka, která působí tlakem na stěnu a tak snižuje riziko krvácení. Ponechává se dva až pět dní. Po odstranění cévky se přechodně může vyskytovat inkontinence, která se ale sama upraví. Trvalá inkontinence jako následek operace prostaty se vyskytuje pouze u jednoho procenta operovaných. Mezi nejčastější komplikace patří krvácení, jen výjimečně vyžaduje opětovnou operaci. Klasicky se setkáváme s tzv. retrográdní ejakulací, kdy sperma je odvedeno do močového měchýře a odtud tělo opouští společně s močí. Tento zákrok je považován za standard při zvětšení prostaty. U nádoru prostaty se používá velice málo, především v situacích, kdy je nádor malý, lokalizovaný v blízkosti procházející močové trubice.

Operace prostaty otevřenou prostatektomií

Druhým klasickým zákrokem je otevřená prostatektomie, zde je prostata zpřístupněna pomocí zevního řezu. Používají se různé přístupy této operace prostaty, a to retropubický – kdy je řez veden v dolní části břicha, další perineální – místem řezu je hráz, tedy oblast mezi konečníkem a šourkem. Tento druhý přístup se ale nepoužívá často pro vyšší riziko poranění nervů a špatně přístupné mízní uzliny. Moderním řešením operace prostaty je laparoskopická operace, kdy je pomocí čtyř malých řezů zaveden robot, který provádí zákrok. Operace se také nazývá robotická. Tato metoda přináší propojení výhod otevřeného přístupu a minimalizace komplikací, kdy na základě menších řezů se rána lépe hojí, je menší riziko krvácení, bolesti jsou samozřejmě také menší. Otevřená prostatektomie se volí při zvětšení prostaty, pokud její hmotnost přesahuje 80g, dále u rakoviny prostaty, pokud je lokalizována pouze do oblasti žlázy. U rakoviny prostaty je vyžadován tzv. radikální přístup, kdy kromě prostaty jsou odstraňovány semenné váčky a svodné mízní uzliny. Komplikace této operace prostaty jsou častější, což je dáno rozsáhlejším zákrokem. Neliší se ale od dříve jmenované metody, na prvním místě je opět krvácení.

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