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Can Part Of The Prostate Be Removed

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Life After Prostate Removal

Robotic Assisted Laparoscopic Radical Prostatectomy | Brigham and Women’s Hospital

For many men with prostate cancer, prostate removal is never needed because the cancer is often slow-growing and managed with non-surgical treatments. But, if the cancer has grown beyond the prostate, the oncologist may recommend prostate removal surgery, also called a prostatectomy. If you are going to have prostate removal surgery, this information can help you in your discussion with the doctors.

When You Might Have A Radical Prostatectomy

Your doctor might recommend a radical prostatectomy if:

  • your cancer hasn’t spread outside the prostate gland. This is localised prostate cancer
  • your cancer has broken through the covering of the prostate and spread to the area just outside the prostate gland. This is locally advanced prostate cancer
  • you are well enough to have this operation

The aim of a radical prostatectomy operation is to cure prostate cancer.

How To Remove Prostate

The process of removing your prostate gland is called a prostatectomy.

A prostatectomy is a surgery where part of the prostate or all of the prostate is removed from your body. It may be done to treat cancer or something called benign prostatic hyperplasia.

Common surgery for the prostate is to cut it out. There are two ways to do this. One way is through your lower abdomen, and the other one is right below your scrotum.

Before you have a prostatectomy, you will need to get a prostate biopsy. It is usually done before the surgery. It will help your doctor know more about your prostate.

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Transurethral Resection Of The Prostate

Transurethral resection of the prostate is a urological operation that involves cutting away a section of the prostate. It is most often used to relieve symptoms of urinary blockage, not necessarily to treat prostate cancer.

An instrument called a resectoscope is inserted through the opening of the urethra and the surgeon removes the inner part of the prostate gland .

The intervention lasts about an hour and it is most often used for non-cancerous blockage, but may also be used in cases of prostate cancer. The doctor doesnt need to make any incisions on the body. While most people can go home the same day, it is also likely that patients spend one or two days in the hospital. After the surgery, a urinary catheter will be placed because of the swelling that blocks urine flow.

What Is Robotic Prostate Surgery

Prostate Cancer and Benign Prostatic Enlargement

A surgical treatment for prostate cancer, the radical prostatectomy procedure removes the entire prostate gland. Radical prostatectomy can now be done by laparoscopic or robotic techniques. In open prostate surgery, the prostate gland is removed through a larger incision in the lower abdomen. Laparoscopic prostate surgery involves key-hole incisions which used for inserting a lighted viewing instrument into the pelvic region and allows examination and removal of the prostate without a large abdominal incision.

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Open Radical Prostatectomy Vs Minimally Invasive Radical Prostatectomy

In 2003, only 9.2% of radical prostatectomies were done using a minimally invasive procedure. By 2007, that number had jumped to 43.2%. In 2009, researchers in Boston reported on a study that compared outcomes, benefits, and complications of open surgery vs. minimally invasive surgery:

  • No difference was found in deaths or in the need for additional cancer therapy between the two approaches.
  • The median hospital stay was two days for minimally invasive surgery and three days for open surgery.
  • 2.7% of men having laparoscopic surgery required a blood transfusion compared with 20.8% of men having open surgery.
  • There was more anastomotic stricture narrowing of the suture where internal body parts are rejoined for open surgery than for minimally invasive surgery .
  • There were fewer respiratory complications with minimally invasive surgery than with open surgery .
  • There were lower rates of incontinence and erectile dysfunction with open surgery. The overall rate was 4.7% for laparoscopic surgery and 2.1% for open surgery.

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Open Or Laparoscopic Radical Prostatectomy

In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.

In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.

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How Is Prostate Cancer Diagnosed

Prostate cancer can only be diagnosed by the results of a biopsy. During a biopsy, a hollow needle is used to remove small tissue samples from the prostate. This is generally done in the office with local anesthesia. A pathologist will then examine the tissue samples under a microscope, checking for cancer cells.

Diet Fluids And Bowel Movements

High PSA & Prostatitis | Ask a Prostate Expert, Mark Scholz, MD

Constipation is a common side effect of pain medications and surgery. You should have received prescriptions for an oral stool softener and a laxative.

You should start drinking fluids as soon as you are comfortable after surgery, and you can resume your normal diet the first day after surgery. But while waiting for normal bowel function to return, you should avoid large meals in favor of several small meals a day. To prevent constipation, we recommend drinking at least eight to 10 glasses of fluids each day and eating lots of fruits and vegetables. Avoid carbonated beverages and cruciferous vegetables such as broccoli, cauliflower, brussels sprouts and cabbage for approximately two weeks, as they frequently cause gassy discomfort and distention.

Take your stool softener and laxative as prescribed. Normal trajectory for return of bowel function is one to two days to pass gas, three to five days for the first bowel movement.

If you haven’t had a bowel movement by day three after your surgery, take oral Miralax , an over-the-counter laxative. You can combine Miralax with the prescribed stool softener and laxative. Follow the instructions on the box. Do not use any enemas or take stronger laxatives, such as magnesium citrate. Contact the clinic if you still haven’t had a bowel movement by day five.

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Caring For The Incision

You will be able to take a shower the second day after your surgery. You may continue to have some discharge at the drain site for three to five days. Once you leave the hospital, the key words on caring for the drain site and incisions are clean and dry. Showering once a day and gently patting the area with a clean towel should be sufficient.

Why Turp Is Carried Out

TURP is often recommended when prostate enlargement causes troublesome symptoms and fails to respond to treatment with medication.

Symptoms that may improve after TURP include:

  • problems with starting to pee
  • a weak flow of pee, or stopping and starting
  • having to strain to pee
  • a frequent need to pee
  • waking up frequently during the night to pee
  • a sudden urge to pee
  • being unable to empty your bladder fully

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What Is The Prostates Role In Urination

When urine is emptied into the bladder from the kidneys, its kept inside the body by a couple of valves that stay closed until your body tells them to open when you urinate.

If youve had your prostate completely removed, youve had a surgery called radical prostatectomy. Along with the prostate gland, the surgeon has to remove one of the valves outside the prostate that open and close to let urine out or keep it in. Usually having one working valve is enough, but there might also be also be some effect on the nerves and muscles in the area from the surgery that allows urine to leak. Approximately 6% to 8% of men whove had surgery to remove their prostates will develop urinary incontinence.

How Soon After Prostate Cancer Treatment Can I Be Sexually Active Again

Prostate Surgery High Resolution Stock Photography and Images

This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial methods like medicines or medical devices . If you were having problems having erections before treatment, this will not get better after treatment.

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Advantages And Disadvantages Of Surgery

What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.

Advantages

  • If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
  • The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
  • Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
  • If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
  • Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.

Disadvantages

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Types Of Prostatectomy Procedures

  • A simple prostatectomy removes all or part of the prostate gland with an incision in the lower belly. This surgery is usually chosen for an enlarged prostate.
  • A radical prostatectomy removes all of the prostate gland and tissue around it. This surgery is usually chosen to treat prostate cancer.

The Urology Specialists of Maryland offer patients expertise in minimally invasive laparoscopic surgery and robotic surgery for prostatectomies.

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Surgery For Prostate Cancer

Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.

The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.

When To Call Your Doctor Or Nurse

Robot-assisted Radical Prostatectomy (RARP)

Its important to tell your doctor or nurse if:

  • your bladder feels full or your catheter isnt draining urine
  • your catheter leaks or falls out
  • your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
  • you have a fever
  • you feel sick or vomit
  • you get cramps in your stomach area that will not go away
  • you get pain or swelling in the muscles in your lower legs.

Your doctor or nurse will let you know if you should go to the hospital.

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Are There Differences Between Orp Lrp And Ralrp

According to a 2010 of different surgery types for prostate cancer, the outcomes for open radical prostatectomy , laparoscopic , and robotic-assisted prostatectomy are not significantly different.

But people who choose LRP and RALRP may experience:

  • less blood loss
  • shorter hospital stay
  • faster recovery time

Also, people who choose RALRP report faster recovery in continence and decreased hospital stay, in comparison to LRP. But the overall outcomes still depend on the surgeons experience and skill.

If There Are No Symptoms How Is Prostate Cancer Detected

Screening for prostate cancer can be performed in a physician’s office using two tests: the PSA blood test and the digital rectal exam . The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50. Men at high risk, such as African American men and men with a strong family history should begin testing at age 45. Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40.

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Impotence After Prostate Surgery

In the past, up to 70 per cent of men who had their whole prostate removed because of cancer had some difficulty achieving an erection afterwards. This is because the prostate lies next to the nerves and blood vessels that are important for erections, and these nerves and vessels can be damaged during the operation. Newer surgical techniques that aim to spare the nerves associated with erectile function have reduced the risk of impotence.

While there is a still a significant risk of erectile dysfunction after prostate surgery, there is often a gradual improvement in erectile function over time. Some men only have short-lived erectile dysfunction and others continue to improve for up to 3 years.

How Turp Is Performed

Prostate surgery

TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts need to be made in your skin.

The loop of wire is then heated with an electric current and used to cut away the section of your prostate causing your symptoms. A thin tube called a catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.

General or spinal anaesthesia is used during the procedure so you don’t feel any pain while it’s carried out.

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What Is The Prostate Gland

The prostate gland is about the size of a walnut and surrounds the neck ofa man’s bladder and urethrathe tube that carries urine from the bladder.It’s partly muscular and partly glandular, with ducts opening into theprostatic portion of the urethra. It’s made up of three lobes, a centerlobe with one lobe on each side.

Researchers don’t know all the functions of the prostate gland. However,the prostate gland plays an important role in both sexual and urinaryfunction. It’s common for the prostate gland to become enlarged as a manages, and it’s also likely for a man to encounter some type of prostateproblem in his lifetime.

Many common problems that don’t require a radical prostatectomy areassociated with the prostate gland. These problems may occur in men of allages and include:

Cancer of the prostate is a common and serious health concern. According tothe American Cancer Society, prostate cancer is the most common form ofcancer in men older than age 50, and the third leading cause of death fromcancer.

There are different ways to achieve the goal of removing the prostate glandwhen there’s cancer. Methods of performing prostatectomy include:

Surgery To Remove Prostate Cancer

Surgery is one of the main treatments for prostate cancer. You usually have surgery to remove your prostate gland. This is a radical prostatectomy.

A radical prostatectomy is a major operation with some possible side effects. You may not need this type of surgery if you’re an older man with a slow growing prostate cancer. This is because your cancer might grow so slowly that you’re more likely to die of old age or other causes than from prostate cancer.

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Side Effects Of Prostate Surgery

The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.

Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:

  • Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
  • Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
  • Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
  • Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.

After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.

There are several options for treating erectile dysfunction:

What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible

Living with advanced prostate cancer

There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.

For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.

These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.

Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.

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