Success Of Radical Prostatectomy
The goal of radical prostatectomy is to cure prostate cancer. But a prostate cancer cure is only possible from prostatectomy if your prostate cancer is limited to the prostate.
During radical prostatectomy, a member of your treatment team examines your removed prostate under a microscope to see if your cancer has reached the edge of the prostate. If so, the prostate cancer has probably spread. In these cases, you may need more treatments.
Men with no evidence of prostate cancer spread have an 85% chance of surviving 10 years after radical prostatectomy.
How Long Will I Have Incontinence After Prostate Surgery
Men will typically have a urinary catheter inserted which will help drain the urine from the bladder after the surgery. The catheter is needed until the urethra heals, which typically takes anywhere from 1-3 weeks. After the catheter is removed, it can take several weeks or more to completely stop leaking. Most men who experience a loss of bladder control have symptoms for 6 months to 1-year post prostate surgery. However, a small percentage of men may continue to experience problems past the one-year mark.
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 to six 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.
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Does Incontinence Go Away On Its Own After Prostate Surgery
For most men, urinary incontinence will go away within about 1 year. The time frame varies depending on how severe your incontinence is, and what types of treatments youre using to manage it. Some men may recover from leaks within weeks, whereas others will take months for the bladder leaks to subside. Performing pelvic floor exercises, also known as Kegels, which help strengthen the muscles that are located in the base of the pelvis between the pubic bone may help to speed the recovery process along.
What Causes An Enlarged Prostate
We still dont really know all the things that cause the prostate to grow. But we do know about two risk factors that can increase your risk of having an enlarged prostate.
Your risk of having an enlarged prostate increases as you get older. Many men aged 50 or over have an enlarged prostate, but they dont all get symptoms. And some men have symptoms that dont bother them.
The balance of hormones in your body changes as you get older. This may cause your prostate to grow.
Some studies show that obese men and men who have diabetes may be more likely to develop an enlarged prostate. Regular exercise may help to reduce your risk of urinary symptoms. But we still need more studies into the causes of enlarged prostate to know for certain if, and how, we can prevent it.
There is also some research that suggests you may be more at risk of developing an enlarged prostate if your father or brother has one. Again, further studies are needed to confirm this.
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Erectile Dysfunction Following Radical Prostatectomy
Assuming the management of erectile dysfunction requires expert diagnosis and treatment.
Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing.
Treatment follows diagnosis, and we provide a range of treatment options through the Clinic. Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis. Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences.
Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic.For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins noted Sexual Behaviors Consultation Unit.
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Will I Have Erectile Dysfunction
Whether or not you experience erectile dysfunction after radical prostatectomy will depend largely on your age, your health and what your erections were like before the operation. This side effect may occur if nerves were injured during the operation.
There are two main nerves running through the pelvis that branch into many nerves covering the prostate. Urologists call them neurovascular bundles because they really are bundles of many nerves. Urologists always aim for nerve-sparing surgery, and we rarely need to remove the neurovascular bundles. But sometimes the bundles are stretched and some of the thousands of nerve fibers within an individual nerve can be damaged, says Mohler. In most men, both neurovascular bundles can usually be spared. If the cancer is advanced, sometimes one or both cannot be.
Benefits of Robotic Radical Prostatectomy
Have more questions about radical prostatectomy? Our experts give you the answers.
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The Morning Of Your Surgery
Instructions for drinking before your surgery
You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take your medications as instructed
A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower with a 4% CHG solution antiseptic skin cleanser
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Dont wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Dont put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Leave valuable items at home.
What to bring
Once youre in the hospital
Get dressed for surgery
When its time to change for surgery, youll get a hospital gown, robe, and nonskid socks to wear.
Meet with a nurse
What Happens During My Operation
A general anaesthetic will be used you will be asleep throughout the procedure. During surgery, you will be given antibiotics by injection.
Robotic-Assisted Laparoscopic Prostatectomy
Robotic surgery is performed via keyhole incisions and uses sophisticated mini-instruments which are under the control of the surgeon. The robot mimics and assists the surgeons movements it does not do the operation. The technique is now widely used because of its high degree of surgical accuracy, and because your recovery is faster than it is for open surgery.
Six small incisions are made into the abdomen through which the robotic instruments are inserted. The robot is placed beside you in the operating theatre. The robot has four arms – three for instruments and one for a high magnification 3-D camera to allow the surgeon to see inside your abdomen. The robotic instruments are small approximately 7mm in width. The surgeon sits in the same rooms but away from the patient and with the robotic technology is able to carry out more controlled and precise movements in a small space within the body.
The muscle fibres and nerves that control continence are preserved.
The skin is closed with absorbable sutures which are located under the skin and are not visible and the outside is sealed with skin glue.
Blood loss is usually less than 200mL and the risk of a blood transfusion is < 2%.
Blood loss is usually around 500mL. The risk of a blood transfusion in my hands is < 2%.
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Urinary Problems After Surgery
Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.
A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.
Watch Pauls story for one mans experience of managing urinary problems after surgery below.
Sexual problems after surgery
Change in penis size and shape
Changes to orgasm
The seminal vesicles, which make some of the fluid in semen, are removed during surgery. This means you wont ejaculate any more. You may have a dry orgasm instead where you feel the sensation of orgasm but dont ejaculate. This may feel different to the orgasms youre used to.
What Happens During Radical Prostatectomy
You will have general anesthesia during your prostate surgery. Your surgical team inserts a catheter to drain urine.
After your surgeon removes your prostate, they check it under a microscope to see if cancer has extended beyond the edge of the prostate or into the seminal vesicles or lymph nodes. If it has, the cancer may have spread. In that case, you may need other treatment.
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Day Before Your Surgery
Follow a light diet
Follow a light diet, such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink, and avoid fried foods and foods with a lot of seasoning.
Note the time of your surgery
A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, theyll call you on the Friday before. If you dont get a call by 7:00 pm, call .
The staff member will tell you what time to arrive at the hospital for your surgery. Theyll also remind you where to go.
Do your bowel preparation
The night before your surgery, use a saline enema as instructed on the box.
Shower with a 4% CHG solution antiseptic skin cleanser
The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.
The First Few Days After Surgery
After the successful completion a robotic prostatectomy you will stay in hospital for one to two nights. You will be mobilised early. Most patients wake up with a catheter tube and a small drain. You will be prescribed painkillers as well.
You can expect to have this catheter in place for a week, however, some patients will require it for longer, depending on the specifics of the surgery. Your urology specialist will detail how to care for your catheter and will assist in its removal when ready.
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Cancer After Prostatectomy: When Surgery Is Not Enough
Three months later, I was back at work, delivering a three day workshop at Warwick University, when I got the call I had been dreading: my first PSA test results. I got a phone call to say
I am sorry Martin, your PSA is still high. We havent caught the cancer. It has spread within your body.
That for me was more devastating than my initial diagnosis.
Id just climbed the mountain of prostate cancer and radical open surgery, and recovered from that only to find there was another even higher mountain to climb. And it is a journey of uncertainty.
I was then passed on from the surgery department to oncology. And I wasnt asked about my wants they simply said, this is what needs to happen and heres who you need to see. I didnt like it then, it felt very impersonal. Now I realise that they were working on the bigger statistical picture. Generally, people whose cancer is not cured by surgery need further treatment from oncologists. They were very matter of fact and technical.
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Keeping Up With Appointments And Screenings
Attending your doctors appointments after youve entered remission is very important. If you need to skip an appointment, you should make another appointment as soon as possible.
Use these appointments as a time to discuss any concerns you may have with your doctor. Your doctor can also conduct tests to check for the cancers return during these appointments.
Two tests to detect recurrent prostate cancer include a digital rectal exam and a PSA blood test. During a DRE, your doctor will insert a finger into your rectum. If your doctor detects something unusual, theyll likely ask for additional follow-up tests. These tests may include bone scans and imaging studies, such as an ultrasound or MRI.
Men often experience side effects from their prostate cancer treatments. Some of these side effects may be immediate and temporary. Others may take several weeks or months to show up and never fully disappear.
Common side effects from prostate cancer treatment include:
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How Long Does A Robotic Radical Prostatectomy Take
Nowadays, men can opt for radical prostatectomy assisted by robots. This modern version offers a faster recovery time. In this case, the surgeon is not located anywhere near the patient, but he is standing behind a computer terminal. Instead, a robotic arm is operating the patient with high precision.
A robotic radical prostatectomy takes as long as a traditional procedure, namely approximately 2 hours. However, theres a more reduced list of side effects involved while the recovery time is narrowed down. During this time, the surgeon assisted by machines executes the following steps:
What Research Efforts Are University Of Florida Surgeons Involved In To Enhance Result Of Robotic Prostatectomy
University of Florida robotic surgeons are involved in several exciting research projects pertaining to robotic pertaining to robotic prostatectomy. First, we are involved with prospective collection of perioperative outcomes for each patient undergoing robotic prostatectomy. In this way, our robotic surgeons track quality of life and cancer outcomes following surgery to assess trends in outcomes and the effects of changes in surgical technique or new technology on these outcome measures. Second, we are investigating new imaging modalities to identify the precise course and location of the neurovascular bundles as well as cancer sites during this procedure using novel MRI technology. Lastly we are developing a robotic surgical simulator to help better prepare and train residents and fellows on the technical nuances of robotic surgery.
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