I-radical prostatectomy

I-Radical prostatectomy (ukususwa kwe-prostate) ukuhlinzwa ukususa yonke indlala yesinye kanye nezinye izicubu ezizungezile. Kuyenziwa ukwelapha umdlavuza wesinye.

Kunezinhlobo eziyisi-4 eziyinhloko noma amasu wokuhlinzwa okuqatha kwe-prostatectomy. Lezi zinqubo zithatha cishe amahora amabili kuya kwayi-4:

• I-Retropubic - Udokotela wakho ohlinzayo uzokwenza ukusika okuqala ngezansi nje kwenkinobho yakho yesisu efinyelela ethanjeni lakho le-pubic. Lokhu kuhlinzwa kuthatha imizuzu engama-90 kuye emahoreni amane.
• I-Laparoscopic - Udokotela ohlinzayo usikeka okumbalwa esikhundleni sokusika okukodwa okukhulu. Amathuluzi amade, amancane abekwe ngaphakathi kokusikeka. Udokotela ohlinzayo ubeka ishubhu elincanyana elinekhamera yevidiyo (i-laparoscope) ngaphakathi kokunye ukusikeka. Lokhu kuvumela udokotela ohlinzayo ukuthi abone ngaphakathi kwesisu sakho ngesikhathi senqubo.
• Ukuhlinzwa ngamarobhothi - Kwesinye isikhathi, ukuhlinzekwa nge-laparoscopic kwenziwa kusetshenziswa uhlelo lwe-robotic. Udokotela ohlinzayo uhambisa izinsimbi nekhamera esebenzisa izingalo ze-robotic ngenkathi ehleli ku-console yokulawula eduze kwetafula lokusebenza. Akuzona zonke izibhedlela ezinikeza ukuhlinzwa ngamarobhothi.
• Okungcwele - Udokotela wakho ohlinzayo usika isikhumba phakathi kwendunu yakho kanye nesisekelo se-scrotum (i-perineum). Ukusikwa kuncane kunendlela ye-retropubic. Lolu hlobo lokuhlinzwa luvame ukuthatha isikhathi esincane futhi lubangele ukulahleka kwegazi okuncane. Kodwa-ke, kunzima ngodokotela ohlinzayo ukuthi agweme izinzwa ezungeze indlala yesinye noma asuse ama-lymph node aseduze ngale ndlela.

Ngalezi zinqubo, ungaba ne-anesthesia ejwayelekile ukuze ulale futhi ungezwa ubuhlungu. Noma, uzothola umuthi wokundikaza ingxenye engezansi yomzimba wakho (i-anesthesia yomgogodla noma ye-epidural).

• Udokotela ohlinzayo ususa indlala yesinye esithweni esiseduze. Ama-vesicles wesilisa, amasaka amabili amancane agcwele uketshezi eduze kwe-prostate yakho, nawo ayasuswa.
• Udokotela ohlinzayo uzonakekela ukudala umonakalo omncane ngangokunokwenzeka emithanjeni nasemithanjeni yegazi.
• Udokotela ohlinzayo unamathisela umchamo engxenyeni yesinye ebizwa ngokuthi intamo yesinye. I-urethra yishubhu elithwala umchamo kusuka esinyeni uye ngaphandle ngepipi.
• Udokotela wakho ohlinzayo angasusa futhi ama-lymph node esikhwameni ukuze awahlolele umdlavuza.
• Umsele, obizwa nge-Jackson-Pratt drain, ungashiywa esiswini sakho ukukhipha uketshezi oluthe xaxa ngemuva kokuhlinzwa.
• Ishubhu (ipayipi) lishiywa emthanjeni wakho nakwisinye ukukhipha umchamo. Lokhu kuzohlala endaweni izinsuku ezimbalwa kuya emasontweni ambalwa.

I-radical prostatectomy ivame ukwenziwa lapho umdlavuza ungasakazekanga ngale kwendlala yesinye. Lokhu kubizwa ngokuthi yi-localized cancer prostate.

Udokotela wakho angakutusa ukwelashwa okukodwa ngenxa yalokho okwaziwayo ngohlobo lwakho lomdlavuza nezici zakho zobungozi. Noma, udokotela wakho angakhuluma nawe ngezinye izindlela zokwelashwa ezingaba nomdlavuza omuhle. Lezi zindlela zokwelapha zingasetshenziswa esikhundleni sokuhlinzwa noma ngemuva kokuhlinzwa.

Izici okufanele uzicabangele lapho ukhetha uhlobo lokuhlinzwa zihlanganisa iminyaka yakho nezinye izinkinga zezokwelapha. Lokhu kuhlinzwa kuvame ukwenziwa emadodeni aphilile okulindeleke ukuthi aphile iminyaka eyi-10 noma ngaphezulu ngemuva kwenqubo.

Izingozi zale nqubo yilezi:

• Izinkinga zokulawula umchamo (ukungahambisani nomchamo)
• Izinkinga zokwakhiwa (ukungabi namandla)
• Ukulimala ku-rectum
• Ukuqiniswa kwe-Urethral (ukuqiniswa kokuvulwa komchamo ngenxa yezicubu ezibomvu)

Ungaba nokuvakashelwa okuningana nomhlinzeki wakho wezokunakekelwa kwempilo. Uzoba nokuhlolwa okuphelele ngokomzimba futhi ungahle ube nokunye ukuhlolwa. Umhlinzeki wakho uzoqinisekisa ukuthi izinkinga zezokwelapha ezifana nesifo sikashukela, umfutho wegazi ophakeme, nezinkinga zenhliziyo noma zamaphaphu ziyalawulwa.

Uma ubhema, kufanele ume amasonto ambalwa ngaphambi kokuhlinzwa. Umhlinzeki wakho angasiza.

Hlala utshela umhlinzeki wakho ukuthi yiziphi izidakamizwa, amavithamini, nezinye izithako ozithathayo, ngisho nalezo ozithenge ngaphandle kadokotela.

Phakathi namasonto angaphambi kokuhlinzwa kwakho:

• Ungacelwa ukuthi uyeke ukuthatha i-aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), nanoma iziphi ezinye izinciphisi zegazi noma izidakamizwa ezenza kube nzima ngegazi lakho ukumboza.
• Buza ukuthi imiphi imishanguzo okufanele usayiphuza ngosuku lokuhlinzwa kwakho.
• Ngosuku olungaphambi kokuhlinzwa kwakho, phuza kuphela uketshezi olucacile.
• Kwesinye isikhathi, ungacelwa ngumhlinzeki wakho ukuthi athathe i-laxative ekhethekile ngosuku ngaphambi kokuhlinzwa kwakho. Lokhu kuzohlanza okuqukethwe kukholoni yakho.

Ngosuku lokuhlinzwa kwakho:

• Ungadli noma uphuze noma yini ngemuva kwamabili ebusuku ngaphambi kokuhlinzwa kwakho.
• Thatha imishanguzo otshelwe ukuthi uyiphuze ngamanzi amancane.
• Uzotshelwa ukuthi ufika nini esibhedlela. Qiniseka ukuthi ufika ngesikhathi.

Lungisa ikhaya lakho uma ufika ekhaya ngemuva kokuhlinzwa.

Iningi labantu lihlala esibhedlela usuku olungu-1 kuya kwele-4. Ngemuva kokuhlinzwa kwe-laparoscopic noma i-robotic, ungaya ekhaya ngosuku olulandelayo ngemuva kwenqubo.

Kungase kudingeke uhlale embhedeni kuze kube sekuseni emva kokuhlinzwa. Uzokhuthazwa ukuthi uzulazule ngangokunokwenzeka ngemuva kwalokho.

Umhlengikazi wakho uzokusiza ushintshe izikhundla embhedeni futhi akubonise ukuzivocavoca ukugcina igazi ligeleza. Uzofunda futhi ukukhwehlela noma ukuphefumula okujulile ukuvimbela inyumoniya. Kufanele wenze lezi zinyathelo njalo emahoreni ayi-1 kuya kwangu-2. Kungase kudingeke usebenzise umshini wokuphefumula ukugcina amaphaphu akho ecacile.

Ngemuva kokuhlinzwa kwakho, unga:

• Gqoka izitokisi ezikhethekile emilenzeni yakho ukuvimbela amahlule egazi.
• Thola umuthi wezinhlungu emithanjeni yakho noma uphuze amaphilisi ezinhlungu.
• Zizwe ama-spasms esinyeni sakho.
• Yiba nepayipi le-Foley esinyeni sakho lapho ubuyela ekhaya.

Ukuhlinzwa kufanele kususe wonke amangqamuzana omdlavuza. Kodwa-ke, uzobhekwa ngokucophelela ukuqinisekisa ukuthi umdlavuza awubuyi. Kufanele uhlolwe njalo, kufaka phakathi ukuhlolwa kwegazi kwe-prostate specific antigen (PSA).

Ngokuya ngemiphumela ye-pathology nemiphumela yokuhlolwa kwe-PSA ngemuva kokukhishwa kwe-prostate, umhlinzeki wakho angaxoxa nawe ngemithi yokwelashwa ngemisebe noma nge-hormone therapy.

I-Prostatectomy - enkulu; I-radical retropubic prostatectomy; I-radical perineal prostatectomy; I-laparoscopic radical prostatectomy; I-LRP; I-laparoscopic prostatectomy; I-RALP; I-pelvic lymphadenectomy; Umdlavuza wendlala yesinye - i-prostatectomy; Ukususwa kwendlala yesinye - kakhulu

• Ukuphepha kwamakamelo abantu abadala
• Ukunakekelwa kwe-catheter ehlala ngaphakathi
• Ukuzivocavoca kukaKegel - ukuzinakekela
• I-prostate brachytherapy - ukukhipha
• I-radical prostatectomy - ukukhishwa
• Ukunakekelwa kwe-catheter ye-Suprapubic
• Ukunakekelwa kwesilonda sokuhlinzwa - kuvulekile
• Imikhiqizo yokungasebenzi kwe-Urinary - ukuzinakekela
• Izikhwama zokudonsa umchamo
• Lapho unesicanucanu nokuhlanza
• Lapho une-incontinence yokuchama

UBill-Axelson A, uHolmberg L, uGarmo H, et al. I-radical prostatectomy noma ukulinda okulindile kumdlavuza wokuqala wesibeletho. N Engl J Med. 2014; 370 (10): 932-942. I-PMID: 24597866 www.ncbi.nlm.nih.gov/pubmed/24597866.

U-Ellison JS, He C, Izinkuni DP. Umsebenzi wokuqala wokuchama nowokuya ocansini uqagela ukutakula okusebenzayo unyaka ongu-1 ngemuva kwe-prostatectomy. J Urol. 2013; 190 (4): 1233-1238. I-PMID: 23608677 www.ncbi.nlm.nih.gov/pubmed/23608677.

Iwebhusayithi yeNational Cancer Institute. Ukwelashwa komdlavuza we-Prostate (PDQ) - inguqulo yezempilo. www.cancer.gov/types/prostate/hp/prostate-treatment-pdq. Kubuyekezwe uJanuwari 29, 2020. Kufinyelelwe ngoFebhuwari 20, 2020.

U-Resnick MJ, uKoyama T, uFan KH, et al. Imiphumela yokusebenza yesikhathi eside ngemuva kokwelashwa komdlavuza we-prostate owenziwe endaweni. N Engl J Med. 2013; 368 (5): 436-445. I-PMID: 23363497 www.ncbi.nlm.nih.gov/pubmed/23363497.

I-Schaeffer EM, i-Partin AW, i-Lepor H. Vula i-prostatectomy enamandla. Ku: Wein AJ, Kavoussi LR, Partin AW, Peters CA, ama-eds. ICampbell-Walsh Urology. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2016: isahluko 114.

USu LM, uGilbert SM, uSmith JA. I-laparoscopic radate prostatectomy ne-pelvic lymphadenectomy. Ku: Wein AJ, Kavoussi LR, Partin AW, Peters CA, ama-eds. ICampbell-Walsh Urology. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2016: isahluko 115.