Monday, May 23, 2022

How Is Prostate Surgery Performed

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What You Need To Know About Your Recovery Period

Robotic Prostatectomy Performed By Dr. Jason Engel

Following your prostate laser surgery, your surgeon will give you a few essential guidelines. Those guidelines will include taking medications weâre mainly talking about antibiotics here exactly as prescribed, and finishing the full course. Though bleeding from your urethra is only to be expected after your procedure, and this bleeding may continue for several days to even several weeks, youâll also receive instructions on when to come back in. Bleeding that gets worse rather than better, passing clots, and blood that is very thick are all situations that warrant a timely follow-up visit.;

Besides those instructions, your surgeon will tell you to take it easy after your surgery, for a set amount of time depending on the exact form of prostate laser surgery you underwent. Yep, that means sitting on the couch or lying in bed reading newspapers or browsing the web, not engaging in exercise, heavy lifting, marathons, or sexual intercourse!;

Following these instructions will contribute to a timely recovery and prevent complications. If, however, you have done something your surgeon told you not to do, and especially if you are experiencing more pain and discomfort after that act, you do need to immediately check in with your surgeon⦠and then listen to their further advice!;

What Should I Expect When I Get Home

When you are discharged from the ward you will need some baggy trousers or track pants as you may find that your abdomen is uncomfortable and the catheter is easier to manage if your clothing is loose.

There will be some blood, urine and mucus which passes ALONGSIDE or through the catheter and is particularly noticeable after passing a bowel motion this is normal. You should wash the area with soap and water to remove this discharge to reduce any irritation. Keeping a high oral fluid intake reduces the risk of catheter blockage.

You may notice some swelling and bruising around the wounds, the penis and the scrotum which takes several weeks to resolve. You may also notice small firm lumps below the wound these are normal and are simply the knots in the suture material used to close the wound. The suture slowly dissolves and will disappear within 3 months. Most men feel quite tired after surgery and this takes several weeks to resolve.

Following surgery, you will be given a prescription for regular pain medication as well as some laxative medication to keep your bowels regular and thus avoid any straining.

Light walking is encouraged straight after the surgery. After four weeks you may resume heavy lifting.

Showering, bathing and getting the wounds wet is fine the skin has been sealed with glue.

Driving is safe once you are comfortable to do so and feel able to make an emergency stop. This would normally be around 3 weeks following surgery.

What Are The Types Of Radiation Therapy Used For Prostate Cancer

Radiationtherapy for prostate cancer can be divided into two main categories.

Externalbeam radiation :Using a machine outside the body, beams of radiation are focused on theprostate gland. This can help relieve symptoms such as pain while limiting thedamage to the tissues surrounding the prostate.

The 4methods of external beam radiation are:

  • Three-dimensional conformal radiation therapy
  • Stereotactic body radiation therapy
  • Proton beam radiation therapy

Brachytherapy:Small radioactive pellets are inserted into the prostate, each one about thesize of a grain of rice. About 100 pellets are used to limit the damage tosurrounding tissues and organs. Brachytherapy is most often used forearly-stage cases and is sometimes combined with EBRT. The pellets can eitherbe inserted for a couple of days for high dosages or a few months for lowdosage depending on the patients overall status.

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What Is Robotic Prostate Surgery

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.

How Turp Is Performed

Open prostatectomy

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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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 starting to urinate
  • a weak urine flow or stopping and starting
  • having to strain to pass urine
  • a frequent need to urinate
  • waking up frequently during the night to urinate
  • a sudden urge to urinate
  • being unable to empty your bladder fully

What Is A Robotic Or Laparoscopic Radical Prostatectomy

Now routine procedures at Cleveland Clinic, laparoscopic or robotic prostatectomy are minimally invasive surgery procedures used to remove the prostate. Both forms of surgery are now routinely offered at the Cleveland Clinic to patients with prostate cancer. Our single-institution experience now exceeds 1000 cases of laparoscopic and robotic prostate surgery performed.

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What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy

Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeon’s sophisticated maneuvers.

Types Of Radical Prostatectomy

Radical prostatectomy surgery: What to expect

The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.

Open prostatectomy

In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus.

Laparoscopic prostatectomy

In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.

Robot-assisted laparoscopic prostatectomy

Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.

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Radical Prostatectomy Retropubic Or Suprapubic Approach

  • You’ll be positioned on the operating table, lying on your back.

  • An incision will be made from below the navel to the pubic region.

  • The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.

  • The prostate gland will be removed.

  • A drain will be inserted, usually in the right lower area of the incision.

  • Who Should Undergo Radical Prostatectomy

    Men younger than age 75 with limited prostate cancer who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.

    Before performing radical prostatectomy, doctors first try to establish that the prostate cancer has not spread beyond the prostate. The statistical risk of spread can be determined from tables comparing the results of a biopsy and PSA levels. Further testing for spread, if needed, can include CT scans, bone scans, MRI scans, and ultrasound.

    If it appears that the prostate cancer has not spread, a surgeon may first offer other options besides surgery. These can include radiation therapy, hormone therapy, or simply observing the prostate cancer over time, since many prostate cancers grow slowly. Depending on how high the risk of cancer spread, pelvic lymph node dissection may be considered, as well.

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    Questions To Ask Before Surgery

    As you think over the options for surgery, ask your doctor these questions:

    • Is there a good chance my condition will get better?
    • How much will it improve?
    • What are the chances of side effects from a treatment?
    • How long will the effects last?
    • Will I need to have this treatment repeated?

    With newer technologies, doctors can do some minimally invasive procedures with tiny cuts or use tube-style instruments that they insert into you. These procedures may not treat the symptoms to the same degree or durability as more invasive surgical options, they do have faster recoveries, less pain afterward and have reduced risks.

    Other times, the traditional and more invasive surgery may be needed. It all depends on your case and what you and your doctor decide is best for you.

    Doctors can choose from these minimally invasive procedures, endoscopic, or open surgeries to treat moderate to severe symptoms. These procedures are also used if tests show that your ability to pee is seriously affected.

    What Happens After Robotic Prostate Surgery

    TURP Surgery
    • Robotic prostate surgery operative time is typically 2-4 hours
    • Hospital stay is typically 1-2 days
    • Our team will be seeing you on a daily basis during your stay in the hospital and will give you detailed after-surgery instructions prior to your discharge home.
    • Foley Catheter typically comes out on day 5 after a cystogram
    • Jackson Pratt drain comes out around the time of Foley catheter removal depending on your individual circumstances
    • No driving for 7 days after prostate surgery
    • No other restrictions in physically activities after surgery – just do what you can tolerate
    • Aspirin can be restarted when you are back to eating regular meals
    • You will be given Viagra upon the removal of the foley catheter. Typically 50mg a night, increasing to 100mg if no response. This is not given to necessarily induce erections, but to help improve the blood supply to your penis. If you have any heart conditions, your internal medicine doctor needs to clear you before taking Viagra.
    • The first PSA check after prostate surgery is at 1 month and then 3-6 months thereafter.

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    Newly Diagnosed With Prostate Cancer Why Choose Robotic Prostatectomy

    When first diagnosed with prostate cancer, its common for men to wonder what the future will hold. Certainly, a prostate cancer cure is a top priority, but then what?

    Dr. David Samadi understands that men want to know:

    • Will I have sex after prostate cancer?

    • How will sex after prostate cancer be different?

    For many men, prostate cancer treatment choice determines these answers.

    If you select robotic prostate surgery your chances of enjoying sex after prostate surgery are very high. Robotic prostatectomy is a minimally invasive prostate removal. It is considered one of the best treatment options for prostate cancer due to its success rate and fast recovery rate.

    The da Vinci robotic prostate cancer surgery system enables the surgeon to make precise movements. This ensures cancer-removal efficiency and sparing of the nerves and muscles that are responsible for the sexual function.

    However, it is absolutely critical to choose a robotic surgeon with a high case volume and extensive prostate surgery experience. The robot does not perform the surgery and technology is no guarantee of success.

    Dr. Samadi explains how the preservation of sexual function is possible:

    If my only responsibility was to remove the cancerous prostate, my job would be much easier, he acknowledges, But patients deserve much more than that. It was paramount that I find a way to remove the prostate gland without damaging functions critical to a comfortable and enjoyable life after recovery.

    Within 30 Days Of Your Surgery

    Presurgical Testing

    Before your surgery, youll have an appointment for presurgical testing . The date, time, and location will be printed on the appointment reminder from your surgeons office. Its helpful to bring the following things to your PST appointment:

    • A list of all the medications youre taking, including prescription and over-the-counter medications, patches, and creams.
    • Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
    • The name and telephone number of your healthcare provider.

    You can eat and take your usual medications the day of your appointment.

    During your PST appointment, youll meet with a nurse practitioner . They work closely with anesthesiology staff . Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.

    Your NP will talk with you about which medications you should take the morning of your surgery.

    Complete a Health Care Proxy form

    If you havent already completed a Health Care Proxy form, we recommend you complete one now. If youve already completed one or have any other advance directives, bring them to your next appointment.

    Sperm banking

    Male Sexual and Reproductive Medicine Program

    Do breathing and coughing exercises

    Exercise

    Follow a healthy diet

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    Risks Of Radical Prostatectomy

    Radical prostatectomy has a low risk of serious complications. Death or serious disability caused by radical prostatectomy is extremely rare.

    Important nerves travel through the prostate on the way to the penis. Skilled surgeons can usually protect most of these nerves during radical prostatectomy. Still, complications from inadvertent nerve damage do occur after radical prostatectomy. They include:

    • Urinary incontinence: More than 95% of men younger than age 50 are continent after radical prostatectomy. Around 85% of men aged 70 or older maintain continence after the operation.
    • Erectile dysfunction : Problems with erections are common after prostatectomy. Still, most men are able to have sex after prostatectomy while using medicines for ED , an external pump, or injectable medications. The younger the man, the higher the chance of maintaining potency after prostatectomy. A period of penile rehabilitation is often necessary.

    Much of the skill involved in radical prostatectomy centers on sparing these nerves during the operation. A man undergoing radical prostatectomy by a surgeon at an advanced prostate cancer center has a better chance of maintaining sexual and urinary function.

    Other complications of radical prostatectomy include:

    • Bleeding after the operation

    Approaches To Radical Prostatectomy Surgeons Can Use Different Approaches And Techniques Toremove The Prostate They Can Make A Large Incision To Reach The Prostate They Can Also Use Laparoscopic Orrobotic Techniques Which Are Done Through Smaller Incisions In The Pelvis Laparoscopicand Robotic Types Of Surgery Are Less Invasive Than An Open Radicalprostatectomy Men Often Have Shorter Recovery Times Less Blood Loss Lesspain And Shorter Hospital Stays With These Procedures Retropubic Radicalprostatectomy Is Done Through An Incision In The Lower Abdomen The Surgeoncan Also Remove Lymph Nodes From The Pelvis Through The Same Incision Incanada A Retropubic Radical Prostatectomy Is The Most Common Approach Toremoving The Prostate To Treat Cancer

    Robotic Surgery for Prostate Cancer

    Perineal radical prostatectomyis done through an incision in the area between the scrotum and the anus. This surgery usually doesn’t take as long to do as aretropubic radical prostatectomy, but it may lead to more problems with gettingan erection . In addition, surgeons can’t removepelvic lymph nodes through the same incision so they would have to do aseparate procedure through a small cut in the lower abdomen to remove them.

    Laparoscopic radical prostatectomyuses a laparoscope and other surgical instruments passed through small cuts. A laparoscopicprostatectomy has some advantages over an open radical prostatectomy, includingless blood loss and pain, shorter hospital stays, faster recovery and less timewith a catheter.

    Robotic radicalprostatectomy is a type of robotic surgery. The surgeon sits near theoperating table and uses remote controls to move robotic arms. The robotic armshave tiny video cameras and surgical instruments that remove tissue throughsmall cuts. The robotic arms can bend and turn like a human wrist. A roboticprostatectomy also has advantages over an open radical prostatectomy includingless blood loss and pain, shorter hospital stays, faster recovery and less timewith a catheter.

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    Was The Surgery Successful

    The prostate gland will be examined under a microscope in the laboratory after it has been removed. The doctor will check the grade of the cancer cells again. and check that the edges of the prostate are clear of cancer, called ‘checking the margins’.

    Negative margins: No cancer cells.Positive margins: Cancer cells found at the edge of the prostate.

    ;These tests are used to predict your response to the treatment along with PSA checks. Your PSA level should drop within weeks of surgery.

    What Is A Radical Prostatectomy

    Surgery to remove the prostate is called a radical prostatectomy. Before the operation, the surgeon will explain what will happen and tell you about the possible side effects. They may also tell you about other treatments that may help in your situation, such as radiotherapy.

    The aim of the surgery is to remove all of the cancer cells. It is usually only done when the cancer is contained within the prostate and has not spread to the surrounding area.

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