Friday, August 19, 2022

I Had My Prostate Removed

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I Don’t Have Erections After Surgery Am I Impotent For Life

EXTRA: How You Will Pee after Prostate Cancer Surgery

Think of your erections as a well conditioned athlete, who has been injured. This injury is going to take time to heal. You should try to remain patient, and remember that this will be an ongoing battle for many months and even years. Rehabilitation of potency is much like a sports injury. Proper conditioning and medical treatment may potentially speed up recovery, but it is not guaranteed.

If you see any fullness in your erections in the months after your robotic prostatectomy surgery, this is a positive sign that some of the nerves are working or re-growing. You are taking the first steps down the potency recovery path. Remember though, as shown in the previous table for open prostatectomy, 25-55% of men do not regain erections.

Recent Findings About Regaining Potency After Radical Prostatectomy

It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.

Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or ‘cauterizing’ the bleeding vessels.

The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.

For comparison we show the standard data on open prostatectomy potency :

Urgent Signs And Symptoms

For emergencies that can’t wait, call 911.

  • You have a persistent or recurring temperature greater than 101 F or repeated chills.
  • Your catheter stops draining urine despite adequate hydration and no kinks in the tubing.
  • Your urine in your Foley catheter is cloudy, foul smelling or persistently bloody .
  • You have no bowel movement by day five after surgery.
  • You have an unexplained severe pain that you didn’t experience while in the hospital.
  • You are nauseated or vomiting.
  • You have asymmetrical leg swelling .
  • You have worsening redness, swelling or drainage from your incisions.

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A Patients Story: Overcoming Incontinence

    Christopher Miller* is a real estate agent who is married and has two sons. About five years ago, at age 56, Mr. Miller was diagnosed with prostate cancer. After a great deal of research and consultations with five doctors, Mr. Miller decided to have a radical prostatectomy.

    Although he considers the operation a success, in that it has apparently eradicated the cancer, Mr. Miller struggled for almost two years to overcome persistent urinary incontinence. For much of that time, he felt ill-served by the medical community. The story of how he eventually overcame this problem may be helpful to other men in the same situation.

    What was going through your mind when you learned you had prostate cancer?

    Like anyone else, I was surprised. You never think its going to happen to you. The biggest fear, of course, is that it might be life-threatening. Even though I knew this is generally a disease that takes a long time to grow, I still wondered how much longer I might have to live. So I thought of things like: Is my family provided for? Are my financial affairs in order? Will my children be secure? Will I ever meet my grandchildren?

    Of course, I was very concerned about my wife. Wed been married 32 years at that point, and I worried about what impact this would have on her. Shes a very strong and good person, and she remained at my side every moment of the time. And that support proved to be invaluable.

    How many physicians did you see before making a treatment decision?

    Additional Treatment After Surgery

    Alcohol After Prostate Surgery

    Additional treatment can come with one of two approaches: treatment given as adjuvant therapy , or as salvage therapy . In the modern era, most additional treatment is given as salvage therapy because firstly this spares unnecessary treatment for men who would never experience recurrence, and secondly because the success rates of the two approaches appear to be the same.

    Regardless of whether an adjuvant or salvage therapy approach is taken, the main treatment options following biochemical recurrence are:

    • Radiotherapy this is the commonest approach. Because scans dont show metastatic deposits until the PSA is more than 0.5 ng/ml and because radiotherapy is more effective when given before this level is reached, the radiotherapy energy is delivered to the prostate bed. This is because we know that this is the commonest site of recurrence in most men, and that 80% of men treated in this way will be cured.
    • Active surveillance this is appropriate for a very slowly-rising PSA in an elderly patient who has no symptoms.
    • Hormonal therapy in many ways this is the least appealing option as it causes symptoms but does not cure anyone, although it does control the recurrence and lower the PSA.

    Also Check: What Does Metastatic Prostate Cancer Mean

    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.

    Side Effects From Radiation

    Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.

    Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.

    Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.

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    What Are The Side Effects

    The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .

    Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.

    ‘just Cant Wait’ Card

    Which is Better – Surgery vs. Radiation for Prostate Cancer?

    You can get a card to show to staff in shops or pubs etc. It allows you to use their toilets, without them asking awkward questions. You can get the cards from Disability Rights UK or the Bladder and Bowel Community. They also have a map of all the public toilets in the UK.

    You could get a key to disabled toilets if you need to access them quickly. You buy the RADAR key from Disability Rights UK. But this should only be used by people who need quick access to a disabled toilet due to a disability or medical condition.

    Recommended Reading: What Foods Are Good For Shrinking The Prostate

    What Is Prostate Cancer

    Prostate cancer develops in the prostatea small gland that makes seminal fluid. It is the second most common type of cancer in men. Prostate cancer usually grows over time and in the beginning stays within the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.

    Prostate cancer that is caught early has a better chance of successful treatment.

    Risk Of A Change In Penis Size Versus Risk Of No Surgery

    While any decrease in penis size can be alarming, a prostatectomy is done as a life-saving surgery. Prostate cancer can be fatal and treatment substantially lowers the risk of death. Many people who are treated for prostate cancer go on to live for many years.

    Talk to your surgeon and your oncologist about your individual risk of serious and minor complications, as well your expected chance of a cure and your estimated lifespan after the procedure, Your doctors will also tell you what to expect in the weeks, months, and years following your surgery.

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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 To Expect After Prostate Removal

    Robot

    Prostate removal is an effective treatment option for prostate cancer. A radical prostatectomy, which removes the entire prostate gland as well as some surrounding tissue, takes a few hours to complete.

    Here are three things you can expect after your prostate is removed.

  • Gradual Recovery
  • Prostate removal is major surgery, so expect some soreness and pain. Youll receive IV pain medications at first, and your doctor may prescribe you pain medication to use at home. You will also have a urinary catheter in place for about the first week, which you might find uncomfortable.

    Most patients are up and moving the day of surgery and go home the following day. Although you will need to rest and gradually resume physical activity, urologist Mina Fam, M.D., emphasizes the importance of movement. I want patients up and walking the same day of surgery because any kind of cancer surgery has a risk for blood clotting, Dr. Fam says. I encourage patients to keep walking during their recovery.

    Expect it to take about four weeks to start feeling back to your normal self if your surgery was done robotically and up to six weeks with a traditional open approach.

  • Changes in Your Sex Life
  • Treatment options include:

    • Counseling

    Work with your doctor to find a treatment that is right for you.

    Another change to expect in your sex life is that, because the seminal vesicles are removed during surgery, you wont ejaculate semen during orgasm.

  • Bladder Problems
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    Get Regular Physical Activity

    Some research has suggested that men who exercise regularly after treatment might be less likely to die from their prostate cancer than those who dont. Its not clear exactly how much activity might be needed, but more seems to be better. More vigorous activity might also be more helpful than less vigorous activity. Further studies are needed to follow up on these findings.

    Side Effects From Hormone Therapy

    Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.

    The severity and length of side effects depend on how long treatment lasts. “If a man has only six months of treatment, their level of testosterone rises again, and they’ll go back to feeling like themselves,” Calvaresi said.

    Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. “If we can manage those other side effects, then often that improves mood,” she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.

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    Types Of Radical Prostatectomy

    The prostate gland lies just under the bladder and in front of the rectum.

    Surgeons choose from two approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other is minimally invasive. That means it involves several small cuts and a few stitches.

    Open Prostatectomy

    There are two ways to do this traditional method:

    Radical retropubic prostatectomy. Before the surgery, youâll get medicine called anesthesia either to help you âsleepâ or to numb the lower half of your body. Then, your surgeon will make a cut from your belly button down to your pubic bone.

    If your surgeon thinks itâs possible that your prostate cancer has spread to nearby lymph nodes, they may remove some of these nodes and send them to a lab to check for cancer cells while youâre still under anesthesia.

    If the lab finds cancer, your surgeon might decide not to go on with the surgery. Thatâs because surgery probably wouldnât cure your cancer, and removing your prostate could bring on serious side effects.

    Radical perineal prostatectomy. For this less-common surgery, your surgeon reaches your prostate through a cut they make between your anus and scrotum. Youâll get anesthesia before the operation.

    Minimally Invasive Surgeries

    There are two minimally invasive procedures used in radical prostatectomy:

    Laparoscopic prostatectomy

    This type of prostatectomy has become more common over the years.

    What Causes Incontinence After Prostate Surgery

    Video 12 – Four Weeks After Surgery – Mark’s Prostate Cancer Experience

    Urinary incontinence is a potential side effect of prostate removal surgery. The prostate is located just below the bladder and surrounds the urethra. Removing it , or using radiation to treat it, can sometimes cause damage to the nerves and muscles of the bladder, urethra, and or sphincter, which controls the passage of urine from the bladder. This can result in urinary incontinence. In this instance, men are usually experiencing stress urinary incontinence, which is a type of incontinence that happens when you place increased pressure on the bladder. Things like sneezing, coughing, working out, and even standing up can cause you to leak urine.

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    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.

    Urinary Problems After Surgery

    Leaking urine

    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.

    Difficulty urinating

    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 Paul’s story for one man’s experience of managing urinary problems after surgery below.

    Sexual problems after surgery

    Erection problems

    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.

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