Within 30 Days Of Your Surgery
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.
Male Sexual and Reproductive Medicine Program
Do breathing and coughing exercises
Follow a healthy diet
Erection After Prostate Cancer Treatment
Following prostate cancer treatment of any kind, it is a possibility that you will no longer be able to have an erection. If you are unable to have an erection following treatment, this condition may last only for a short time or could be permanent.
All of the currently available, potentially curative treatment options for prostate cancer can result in temporary or permanent erectile dysfunction , though many men who undergo treatment for prostate cancer see little or no ill effects to their erectile function. Radiation therapy, prostate surgery, cryotherapy, hormone therapy, and others can all result in ED.
Unfortunately, there is no definitive way to determine which men will have ED following treatment. In general, men with vascular conditions, diabetes, obesity, or pre-existing erectile problems are at greater risk for ED.
Studies that have sought to determine the chance of men having ED following prostatectomy, radiation, and other prostate cancer treatments have resulted in widely varying numbers. Some studies seem to show that only a small percentage of men have long-standing issues with ED, while others have shown much higher numbers.
For men who have undergone prostatectomy, long-term ED has been seen in up to 67% percent of men, but some studies have shown that using medications such as Viagra may help to achieve erectile functioning.
When To Get Tested
You’ll have your first follow-up PSA test 1 to 3 months after your surgery. You need to wait because some PSA stays in your blood after your prostate is removed. If you wait until it has cleared, that will make an accurate result more likely.
Then you’ll have repeat PSA tests once every 6 to 12 months for about 5 years. If your doctor says chances are high that your cancer will come back, you may need them once every 3 months. If your PSA levels stay normal, you can switch to once-a-year PSA tests. Ask your doctor how often you’ll need a test.
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Management Of Erectile Dysfunction
Oral medications relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working, and the erection-helping effects can last from 8 to 36 hours.
About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs. However, they are not for everyone, including men who take medications for angina or other heart problems and men who take alpha-blockers.
How Are Large Incisions Avoided During Laparoscopy
Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope. This is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor. The advantages of this technique over traditional open surgery include:
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What Your Psa Numbers Mean
The PSA test measures the level of prostate-specific antigen in your blood. The lab will report your results in nanograms of PSA per milliliter of blood.
Only the prostate gland releases PSA, so your numbers should drop to almost zero within 4 weeks after your surgery. A test result above 0.2 ng/mL a few months after your procedure could be a sign that your prostate cancer has come back. This is called a biochemical recurrence.
If your number is higher than it should be, it doesn’t mean you definitely have cancer. Results can vary from person to person and from lab to lab. A more accurate way to find out if you have cancer is to test how quickly your PSA levels rise.
A PSA velocity test measures the change in your PSA levels over time. PSA doubling time tests calculate how long it takes for your PSA levels to double. If they rise quickly, it could be a sign of cancer. Knowing how fast yours is rising can help your doctor predict whether your cancer will spread, and if — or when — you’ll need treatment.
Don’t Take Your Meds As Prescribed
You may shrug off pain medication because you heard it’s addictive or it makes you constipated, nauseous, or woozy. But skimping on your medicine isn’t smart.
Pain can sometimes interfere with your sleep, appetite, and ability to get around, Whiteson says. And that can make it harder for your body to heal. Ultimately, the goal is to get off medication, but not before you’re ready.
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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 The Advantages Of Cleveland Clinic’s Prostate Surgery Program
These procedures are performed through small key-hole incisions that do not cut muscle. Laparoscopic and robotic prostatectomy offer surgeons unparalleled visualization of the area, thus permitting precise removal of the prostate. Patients also experience significantly less blood loss. Additionally, patients benefit from:
- Reduced hospital stay after surgery and faster healing
- Less postoperative pain and virtually no need for pain medication
- Earlier removal of catheter
- Shorter recovery time
- Quicker return to normal activity and work
- Smaller “Band-aid” incisions and less scarring
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Why Is A Prostate Biopsy Done
A prostate biopsy is done to screen for prostate cancers. This is to confirm whether cancer is present, or if a prostate cancer diagnosis is aggressive. In a prostate biopsy, small samples of the prostate are removed and then observed under the microscope. Doctors usually recommend a biopsy of the prostate gland based on certain findings.
- If prostate-specific antigen blood test results are higher than the average age
- If the doctor detects signs of a prostate problem during a digital rectal exam
- If a biopsy is the only method to confirm the cancer
A prostate biopsy involves:
- Collecting minute samples of the prostate gland. A computed tomography or magnetic resonance imaging scan is also used to guide them through the procedure.
- A prostate biopsy takes about 10 minutes and is usually done in the doctors office. The samples will be sent to a lab and will be looked at under a microscope to see if they contain cancer cells.
- If cancer is detected in the patient, it will also be assigned a grade. The results are available after one to three days, but it can sometimes take longer.
A prostate biopsy may be done in several different ways which may include:
Facts Every Man Should Know Before Prostate Cancer Surgery
Many men want to know what prostate cancer surgery is like, including what to expect before surgery and what to expect afterwards.
Here are my findings based upon more than 1,000 phone calls to men the day before surgery, almost 700 visits to men the day after surgery and hundreds of calls from men in the weeks following surgery.
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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.
Quit Your Breathing Exercises
If you’ve had surgery on your belly, heart, lung, or spine, your doctor may give you exercises to help your lungs recover from anesthesia, the medicine that kept you pain-free during the operation.
“Doing breathing exercises is very, very important,” Whiteson says. It expands your lungs and removes mucus that gathers there. Don’t quit until your doctor says you can stop.
To keep your recovery humming along, follow your doctor’s directions. As Saggio knows well, taking things into your own hands can slow down the healing.
“I was a little stoic. I definitely rushed my recovery,” he says. Next time, perhaps, he’ll take that extra week off.
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Lower Risk Of Bladder Neck Contracture
When the prostate gland is removed , the urinary tract must be put back together by sewing the urethra to the bladder. As this junction heals, it tends to narrow, which can lead to significant problems urinating. This condition is called bladder neck contracture . According to the medical literature, as many as 1 in 5 men develop BNC following prostate surgery. William A. See, MD, Medical College of Wisconsin urologic surgeon, has pioneered a new technique for urinary tract reconstruction called intussuscepted vesico-urethral anastomosis .
Based on data from hundreds of surgeries at Froedtert & the Medical College, this technique appears to reduce significantly the risk of developing BNC. For well-selected patients, the risk is approximately 1 in 400. IVUA can be performed in an open prostatectomy, but at this time it cannot be performed robotically.
What Are The Benefits To Patients Who Have Laparoscopic And Robotic Prostate Cancer Surgery
The benefits are similar between robotic and laparoscopic prostate surgery. Patients are usually able to go home the day after prostate surgery, and can return to daily living activities as early as 7-10 days after surgery. Patients undergoing open surgery generally have 4-6 weeks before they can resume routine daily living activities, generally experience less post-operative pain and discomfort and have a faster recovery. They also experience significantly less intraoperative bleeding. Robotic and laparoscopic prostatectomy uses small incisions and is highly precise the risk of incontinence is low and the surgical technique is continuously refined to improve potency.
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What Happens After Robotic Prostate 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.
Whats The Biggest Mistake You Can Make After Surgery
His attempt to quickly get his groove back was a big mistake. Saggio was socked with pain, discomfort, and diarrhea and had to press the restart button on his recovery. As a general surgeon and assistant professor at NYIT College of Osteopathic Medicine, Saggio knows he made a classic post-surgery mistake.
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What To Do Next
Learning that your PSA level is higher than it should be can be very stressful. Talk to your doctor about what your results mean and your next steps. You may need more treatment, or you might be able to wait and have regular PSA tests to watch your cancer.
It’s important to remember that your PSA test doesn’t tell the whole story. Levels can go up and down, and they’re different for each person. Even if you do still have cancer or your cancer has come back, it may not spread for a long time.
If your cancer does come back, treatment options include radiation in the area where your prostate used to be, and hormone therapy. Having these treatments can reduce the risk that your cancer will grow and spread.
What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy
Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .
Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.
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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.
What You Need To Know About Prostate Surgery
What is prostate surgery for?
The prostate is a gland located underneath the bladder, in front of the rectum. It plays an important role in the part of the male reproductive system that produces fluids that carry sperm.
Surgery for partial or complete removal of the prostate is called a prostatectomy. The most common causes for prostate surgery are prostate cancer and an enlarged prostate, or benign prostatic hyperplasia .
Pretreatment education is the first step to making a decisions about your treatment. All types of prostate surgery can be done with general anesthesia, which puts you to sleep, or spinal anesthesia, which numbs the lower half of your body.
Your doctor will recommend a type of anesthesia based on your situation.
The goal of your surgery is to:
- cure your condition
- maintain the ability to have erections
- minimize side effects
- minimize pain before, during, and after surgery
Read on to learn more about the types of surgery, risks, and recovery.
The goal of prostate surgery also depends on your condition. For example, the goal of prostate cancer surgery is to remove cancerous tissue. The goal of BPH surgery is to remove prostate tissue and restore the normal flow of urine.