What Is Urinary Incontinence And How Is It Related To Prostate Cancer Surgery
If youve had prostate cancer surgery, you might experience stress incontinence, which means you might leak urine when you cough, sneeze or lift something that is heavy. This happens because of stress or pressure on the bladder. There is also a type of incontinence that is called urge incontinence. When this happens, you are hit with a sudden need to urinate right away and have leakage before you can make it to the bathroom.
Can Impotence Occur After Prostate Surgery
Consider your options
If youre undergoing prostate surgery, you may be concerned about how it will affect your sexual function. Erectile dysfunction is the inability to become sexually aroused and have an erection.
The condition has many complex causes. It can be caused by a physical problem, an emotional issue, or both. Regardless of the cause, ED can affect both you and your partner.
Many body systems play a role in sexual arousal. These include:
- the brain
Where Does This Leave You
Increasing availability of these previously expensive drugs is a tremendous help for men who have undergone radical prostate surgery. Despite the uncertainty regarding penile rehabilitation, there is no doubt that real-time erections often improve while on Viagra and so straightforward access to these drugs is essential for a speedy return to a functioning sex life after cancer, for those who want it.
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Where Can I Find Prostate Cancer Support Groups
Even though once you complete the surgery you most likely will find yourself cancer-free, the anxiety and stress may never totally go away. The support of your friends and family is essential in these moments, but the most relief you will find is among people that have gone through the same experience.
We advise you to search locally for prostate cancer or cancer survivors support groups and discuss your journey in beating this. You will find there plenty of people that lived through the same emotions and painful experiences and you will gather your strength to overcome this and not let it define the rest of your life.
If physical presence is not an option for you, there are plenty of forums and online communities that gather around this subject. You can find people that share their experiences and advice below:
Prostate cancer surgery is not as severe of a surgery as other ones. The recovery, especially after robotic surgery, usually lasts up to 2 to 3 weeks and patients can return to work and to living their normal lives.
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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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.
- 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.
How Does Prostate Surgery Cause Erectile Dysfunction
Surgery to remove the prostate is usually offered to men who have prostate cancer that hasnt spread outside of the prostate, or has only spread a small way.
A radical prostatectomy procedure completely removes the prostate plus the tissues and lymph nodes that surround it. It also removes the seminal vesicles, the tubes that carry semen from the testicles. This means that although youll still be able to experience an orgasm after this kind of surgery, you wont ejaculate as no fluid is now being formed.
Its possible, if your cancer is confined to your prostate, to have a procedure called a nerve sparing prostatectomy. This means that your surgeon aims to leave the nerves that are either side of the prostate behind. These nerves are responsible for controlling erections. If theyre left undamaged, then theres more chance that youll be able to achieve an erection unaided after surgery.
If the nerves are damaged or removed, then youre likely to experience erectile dysfunction. In some men, this is permanent, in others they are able to achieve an erection within a few months, with or without medical help.
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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.
Why Prostate Surgery Causes Incontinence
Your bladder stores urine until your brain signals its time to release it. The urethra is a tube that transports urine from your bladder to the outside of your body. There are two valves, called sphincters, on your urethra that open to release urine.
Your prostate gland surrounds your urethra and is located near one of those sphincters, and when you have your prostate removed, one of your sphincters is removed as well. Most of the time, having one functioning valve to hold in or release urine may be sufficient, but in some cases the nerves and muscles in the area are affected and urinary incontinence is the result. Prostate removal surgery may include complete removal for cancer or partial removal to treat an enlarged prostate.
Are These Erections Lost For Good
Theres pretty good evidence to show that men can continue to recover erectile function up to two years after prostatectomy surgery , which we believe is partly because it takes time for the bruising and scar tissue after surgery to settle down. But if spontaneous erections do not recover by this point then it is unlikely that they will do so thereafter. Conversely, there is good evidence that drugs such as Viagra can be used to enhance erections after surgery and that, even if such drugs do not work for example if the nerves have been removed to maximise cancer clearance mechanical devices such as vacuum pumps, cavaject injections into the side of the penis or MUSE therapy are effective.
Why Would Someone Choose Surgery To Treat Incontinence
Urinary incontinence is one of the most bothersome symptoms after prostate surgery. When people suffer from incontinence, they may become depressed, may no longer participate in daily activities that they used to, and may even be reluctant to spend time with friends due to potentially being embarrassed after an accident. Surgery with a urethral sling or artificial urinary sphincter is an excellent option because they can change lives and restore function.
If youve had prostate surgery and found that youre experiencing urinary incontinence, schedule an appointment with Dr. Chung. He can evaluate your situation and suggest a treatment plan for you.
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What Do We Know About Potency After A Robitic Prostatectomy
The return of potency is dependent on several factors:
- Previous sexual function before surgery. Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery. It will not improve upon what you already had before surgery.
- Age. Theyounger you are, the better your chances. Men under 65 have abetter chance of regaining potency, or erectile function than those over 65.
- How many nerves are spared. As discussed previously, ideally both nerves can be spared and thiswill give you the highest chance of regain erections. However,even men with no nerve sparing can regain erectile function.
Ejaculation will no longer occur in any patient. This is because the seminal vesicles and the vas deferens , are removed and cut during the surgery. This means that you will no longer be able to father children
What Are Pelvic Floor Exercises And Can Improve Erection Quality
As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.
Those muscles are the core of how your body maintains blood flow to the penis and therefore keeps erections strong.
They put pressure on the veins in your penis, preventing blood from flowing back into the rest of your body. If they arent strong enough then even if you can get an erection, you wont be able to keep it.
The process starts with identifying the muscles you need to activate. Thats best achieved by lying down with knees bent and feet flat on the floor. Thats when you breathe out and squeeze your pelvic floor muscles for 3 seconds.
Its important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.
Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.
Some men find that after the initial strengthening that options like Pilates become appealing as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.
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Why Is Surgery Needed For Prostate Cancer
If you have prostate cancer, it may be necessary to remove your prostate gland. This isnt always the case, as some men can have their prostate cancer treated by radiotherapy without the need for surgery. Surgery to remove your prostate gland is called a radical prostatectomy, usually performed with the use of a robot.
If you do need your prostate gland removed, its because your doctor believes doing so will cure or control your cancer so that your life can carry on as normal as possible. In cases of advanced prostate cancer that has spread outside your prostate, your doctor may still opt to remove your prostate gland in order to slow down your symptoms and prolong your life.
Your doctor will discuss your options with you.
Prostate Surgery May Shorten Penis
But Reductions Are Slight for Most and May Not Be Permanent
In a newly published study, one in five men who had prostate cancer surgery had a 15% or more decrease in penis length. Though the majority of men had very slight decreases, researchers say men undergoing prostate cancer surgery should be warned of this potential outcome.
“For whatever reason, many men focus on the size of their penis,” urologist Mark S. Soloway, MD, tells WebMD. “It is a big deal to some people, so I think it should definitely be mentioned to men who are facing this surgery.”
But while size does seem to matter, Soloway says most men with prostate cancer are much more concerned about two other common side effects of prostate cancer surgery — urinary incontinence and impotence.
“I see about 10 new men a week with prostate cancer, and the main thing they are concerned about is curing their cancer,” Soloway says. “The next thing is that they don’t want to lose urinary control, and erections are further down the list.”
Prostate cancer is the most common malignancy among men and also one of the most treatable if caught early. More than 80% of prostate cancers are diagnosed in the early stages, and almost all of these men are cured of their cancer.
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Incontinence After Prostate Surgery: Everything You Need To Know
Alan was 68 years old when he had a prostatectomy. My doctor thought it was the best way to treat my prostate cancer and I agreed, he said. We talked about the risks involved, how to prepare for the surgery, and what would happen during the surgery, but it was what happened after prostate surgery that I didnt expect. He never told me about the potential for bladder leaks.
I thought it was probably normal to have some incontinence after prostate surgery, but 6 weeks after I had the catheter removed, I was still unable to stand up without leaking urine. Ill never forget the day I had my catheter taken out. I came home, had a beer to celebrate, and immediately it all just rushed out of me when I stood up a half-hour later. I just didnt expect this to happen and was really worried that it was going to become a permanent part of my life.
I went in for a checkup, and thats when my doctor told me that this is a common side effect for some men. He told me that the leaks would likely recover with time, and he went through my options and discussed what I could do to help speed up the recovery process, which was helpful. I just wish he would have told me all this sooner, before the surgery. At least then, I could have known what to expect.
Alans story isnt uncommon. Undergoing a prostatectomy can be difficult. And for many men, finding that they are incontinent post-surgery may come as a shock.
How Long After The Surgery May I Start Using The Penis Pump For Rehabilitation Exercises
Most men are advised to begin using a vacuum constriction device within two months of nerve-sparing radical prostatectomy. A survey of more than 600 urologists from the American Urological Association showed that the overwhelming majority of physicians start rehab within four months of prostate surgery.
Authors Dalkin BL and Christopher BA published a clinical study in the International Journal of Impotence Research. In an article titled Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device. Sep-Oct 19:501-4. Epub 2007 Jul 26. In this article, they describe when the participants of the study used a penis pump for penile rehabilitation. Daily use of a vacuum erection device was begun the day after catheter removal and continued for 90 days. It is recommended to work with your physician to determine when to start using the penis pump for rehabilitation exercises.
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How Important Is Nerve
The short answer is very. All men in these studies had some form of nerve-sparing performed during their surgery so this review was not able to assess the effect of nerve-sparing on subsequent recovery of erections as there was no control group to compare to. Previous studies have convincingly demonstrated the critical nature of nerve-sparing . The decision to undertake nerve-sparing is made in advance by the surgeon and depends on the extent of cancer. Robotic surgery has allowed more precise and meticulous surgical dissection of the surrounding layers of the prostate. Indeed, 80% of UK prostatectomies are now completed with a da Vinci robot, the remainder split evenly between laparoscopic and open surgery. The outer layers of the prostate are a bit like an onion with several layers. The layer containing the nerves is like the brown skin on the onion and the surgeon can choose to cut inside this layer to leave the brown skin in place.
How Will Sex After Prostate Cancer Be Different
One of the treatments of prostate cancer is to remove a portion of the prostate or the totality of the gland before cancer spreads beyond it You may have heard that the tumor is inside the capsule, but moving fast.
The procedure is known as radical prostatectomy and involves incisions, either above the perineum or on the lower abdomen.
Newer surgeries are sometimes robot-assisted, and we also have laparoscopic prostatectomies that do not require a large incision.
The end result is the removal of a portion or the totality of the prostate, and certain surgical approaches may be associated with a lower risk of nerve damage than others. Youll see this referred to as nerve-sparing prostatectomies throughout this guide.
As soon as a man is informed that he will need to go through a Radical Prostatectomy, the likelihood is that one of the very first questions will be about the effect that it will have on their sex life. In a lot of mens minds, the surgery is thought of like its castration.
However, now that there are multiple types of nerve-sparing prostate surgery, many men have found they can maintain sexual activity after surgery.
Likewise, there are plenty of sexual activities open to those who do find they still have the desire, even with some physical changes. We want to help you understand the changes that men can experience after prostate surgery, whether that is physical or mental.
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