A Change In Patient Perception
Screening for prostate cancer has led to increased public awareness and early detection, as well as a decline in mortality rates. Robotic radical prostatectomy is also a contributing factor to these encouraging trends. This state-of-the-art surgical procedure can offer the best chance for complete recovery. Wristed instrumentation, tremor filtration and 3D magnification aid the surgeon in performing one of the most demanding aspects of the procedure nerve-sparing for preservation of post-operative sexual function and urinary control. Along with cancer control, these are key elements in follow-up for patients undergoing treatment.
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Causes And Surgical Considerations For Prevention
Although the development of urinary incontinence can be explained by intraoperative injury to various structures affecting urinary continence, postprostatectomy erectile dysfunction has more simple causes, and the most important factor is injury to the cavernosal nerves. These nerves are the most important structures in maintaining healthy erectile function owing to their anatomical relationship with the prostate, running in the 3 and 9 oclock directions from the apex of the prostate, and along the posterolateral aspect of the prostate body, injury during radical prostatectomy is inevitable, and this results in postoperative erectile dysfunction. Mechanisms for this nerve injury include unintended physical damage to the nerve itself during surgery, but the extent of nerve injury is reported to differ, and neuropraxia, in particular, is known as a representative mechanism of nerve injury capable of recovery and rehabilitation . Owing to continual efforts to minimize intraoperative nerve injury, when complete resection is not oncologically necessary in patients with preserved preoperative erectile function, bilateral nerve-sparing surgery has become a major trend in modern surgery. Minimizing unintended intraoperative damage to the NBV is considered the most important principle in preserving erectile function.
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 Pauls story for one mans experience of managing urinary problems after surgery below.
Sexual problems after surgery
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What Can I Expect Before And After Robotic Prostatectomy
If after consulting with Dr. Engel, becoming educated on the topic of prostate cancer, potentially seeking other opinions, and being presented all options, a patient opts for robotic prostatectomy, he will then be taken extensively through what to expect. Dr. Engel currently performs robotic surgery exclusively at George Washington University Hospital, and a date and time will be scheduled for surgery there. The patient will generally be urged to see his internist for a pre-operative physical, although this can also be accomplished at the hospital itself. Tests to rule out spread of cancer such as a bone scan and CT scan, looking for spread to bones and lymph nodes, may be performed in higher risk cases. The patient will be given detailed instructions regarding a bowel preparation regimen and the patient must follow this strictly. The purpose of the bowel prep is not only to create more space in the abdomen, but also for safety in the very unlikely event that there is an inadvertent injury to the intestine or rectum during the surgery. If this occurs, a bowel prep will likely keep this from being a life threatening problem.
Dealing With Urinary Issues After Surgery
Inform your doctor about the side effects youre experiencing, especially if urine is blocked. You should also call your doctor if the blood in the urine is thick.
Other, more specific, and serious side effects may also occur. This is particularly the case with radical prostatectomy. The most common adverse reactions here are urinary incontinence and erectile dysfunction.
A man with urinary incontinence may not be able to control urine. Or he may experience leakage or dribbling. Not all cases of urinary incontinence are the same. They may include stress incontinence, overflow incontinence, urge incontinence, and continuous incontinence.
Its useful to remember bladder control may return within several weeks or months post-op. The recovery in urinary control develops gradually. A doctor cant really predict how long this is going to last.
Generally speaking, older patients experience more incontinence problems than younger men. Healthcare professionals will explain how to manage incontinence. Management strategy may include pelvic floor exercises. They strengthen pelvic floor muscle and may improve bladder control.
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Open Radical Prostatectomy Vs Minimally Invasive Radical Prostatectomy
In 2003, only 9.2% of radical prostatectomies were done using a minimally invasive procedure. By 2007, that number had jumped to 43.2%. In 2009, researchers in Boston reported on a study that compared outcomes, benefits, and complications of open surgery vs. minimally invasive surgery:
- No difference was found in deaths or in the need for additional cancer therapy between the two approaches.
- The median hospital stay was two days for minimally invasive surgery and three days for open surgery.
- 2.7% of men having laparoscopic surgery required a blood transfusion compared with 20.8% of men having open surgery.
- There was more anastomotic stricture narrowing of the suture where internal body parts are rejoined for open surgery than for minimally invasive surgery .
- There were fewer respiratory complications with minimally invasive surgery than with open surgery .
- There were lower rates of incontinence and erectile dysfunction with open surgery. The overall rate was 4.7% for laparoscopic surgery and 2.1% for open surgery.
Risks Of Radical Prostatectomy
Radical prostatectomy has a low risk of serious complications. Death or serious disability caused by radical prostatectomy is extremely rare.
Still, complications from unintended nerve damage can happen after radical prostatectomy. They include:
Urinary incontinence. This means trouble controlling your urine, leaking, or dribbling. If you have incontinence, talk to your doctor about treatments that can help.
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 you are, the higher the chance that youâll be able to get erections after surgery.
Most doctors think you can help yourself regain your ability to get erections if you try to get one as soon as possible once your body has had time to heal â often several weeks after your surgery. This is called âpenile rehabilitation.â Talk to your doctor before you try it.
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 keeping their sexual and urinary function.
Other complications of radical prostatectomy include:
- Bleeding after the operation
- Narrowing of the urethra, blocking urine flow
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Counseling And Psychological Evaluations
In some cases, causes of erectile dysfunction are a combination of organic and psychological factors. For example, you could be achieving a partial erection, and since youre used to more rigid erections, it makes you insecure, and the problem gets worse over time. Counseling can be helpful in these cases.
Postoperative Care After Prostate Surgery
After a healthy operation and discharge, there are some rules that you must follow. There is a risk of bleeding for the first several months after surgery. Therefore, there are some points to take into consideration. The length of the recovery period after prostate cancer surgery varies depending on some conditions. There are factors such as the type of surgery, the stage of disease, and the patientâs health status. However, overall recovery time is short.
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Turning Off Your Artificial Urinary Sphincter:
Once your AUS is on, there may be certain times when your AUS should be turned off. Your caregiver will show you how to turn the AUS on and off. You may need to turn off your AUS at the following times:
- At night: Your caregiver may tell you to turn off your AUS each night when you go to bed. Turning off the AUS helps decrease pressure on your urethra and helps prevent damage. You can wear a pad at night to help absorb any urine leakage.
- At the end of a pregnancy: Pregnant women may need to turn off their AUS for the last three months of pregnancy. Turning off the AUS decreases the pressure on the urethra and helps prevent damage. Turning off the AUS also helps prevent AUS cuff damage from the pressure of the unborn babys head. Talk with your caregiver if you have any questions or concerns about your AUS and pregnancy.
- For procedures: You may need to turn off your AUS before procedures that involve your urinary tract. These procedures include urinary catheter placement or a cystoscopy . Your caregiver may give you a card to carry that has information about your AUS. Show the card to caregivers to see if your AUS should be turned off during a procedure.
How Is Urinary Incontinence After Prostate Surgery Treated
If you find youre having issues with mild to moderate leakage after surgery, your healthcare provider might suggest starting with noninvasive therapies like medications or physical therapy exercises for the pelvic floor muscles. These treatments may also cut down on the number of times that you have to get up each night to pee.
These methods can sometimes help men who have mild to moderate leakage. Men who have persistent leakage or a more severe problem may need surgery if they do not want to continue to use pads.
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What Is Robotic Laparoscopic Surgery
Robot-assisted surgery in prostate cancer treatment is a new innovation. It consists of using robotic equipment which, unlike what some patients may think, is fully controlled by the doctor. The robot replicates the surgeons movements , performing the very precise movements, or orders, they execute.
These very sophisticated pieces of equipment allow surgeons to remove the prostate and surrounding tissue accurately and precisely.
It is a variant of keyhole surgery, maintaining its essential benefits while making operations quicker, more delicate and more precise.
It is a far less invasive procedure than conventional radical retropubic prostatectomy which involves an abdominal incision from the navel to the pubic region.
For patients, it translates into a shorter recovery time and shorter hospitalisation.
For patients operated on and cared for at the Instituto da Próstata, the Da Vinci System is used.
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.
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Getting Ready For Surgery
You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if youre not sure.
- I take a blood thinner, such as:
About Drinking Alcohol
The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know youre at risk for these problems, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
- Be honest with your healthcare providers about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
- Get a headache.
- For information about being a health care agent, read How to Be a Health Care Agent.
- If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.
Sperm banking
Male Sexual and Reproductive Medicine Program
Exercise
For Caregivers
Mri Technology Revolutionizes Screening Results
Advances in magnetic resonance imaging technology over the past five years have revolutionized the way we screen men for elevated levels of prostate-specific antigen a protein made in the prostate and released into the bloodstream.
Men with prostate cancer typically have elevated levels of PSA. Previously, when high levels were detected through a PSA blood test, we would conduct a biopsy to collect and test prostate gland tissue for cancerous cells. This process had several drawbacks:
- PSA tests can show elevated levels when no cancer is present.
- Elevated PSA can be a sign of other conditions, such as benign prostate enlargement, a urinary tract infection, or an inflamed prostate gland.
- Not all prostate cancers are life-threatening, since the cancer is slow growing in many men. Thus, the current goal is to identify patients at high risk of having clinically significant prostate cancer while avoiding unnecessary biopsies in men at low risk.
Using advanced MRI technology, weve reduced the number of biopsies we perform by almost half while detecting the same number of cancer cases. Getting sharper, clearer MRIs also helpsclinicians and patients make better decisions about who should undergo biopsy for prostate cancerand who might benefit from certain treatments, including nerve-sparing robotic prostatectomy.
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One Week After Surgery
After one week to ten days, your catheter will generally be removed by a urology nurse in the hospital. You will also meet Dr Arianayagam to go through the pathology results and discuss any extra treatments if needed. Pelvic floor physio therapy is restarted at this point and we also commence PDE5 inhibitors and penile vacuum devices as well to aid in recovery of erectile function. You should be active but still focus on your recovery as your body will still need to heal.
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What Happens During Laparoscopic Prostatectomy
You will be placed under general anesthesia. This will put you to sleep for the duration of the surgery. Then your surgeon will make small incisions to insert surgical instruments and a camera.
The surgeon then removes the prostate gland from the surrounding tissue. The seminal vesicles, two small fluid-filled sacs next to your prostate, are also removed. The surgeon will reattach the urethra to a part of the bladder called the bladder neck.
At this point, your surgeon may also remove the lymph nodes for biopsy to check for cancer.
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Dealing With Erectile Dysfunction After Surgery
On the other hand, a man with erectile dysfunction cannot achieve and maintain an erection for sexual penetration. Two tiny bundles of nerves on the sides of prostate control erections.
If a patient has erections before surgery, the surgeon will attempt not to injure those nerves. In other words, they will use a nerve-sparing technique. However, if cancer affects areas close to the nerves or is growing into them, the surgeon will have to remove those nerves as well.
Upon removal of both nerves, a man is unable to achieve a spontaneous erection. That doesnt mean they will never have an erection, though. Today, several aides can help a man achieve an erection.
Its useful to mention a patient may have erections when nerves on one side of the prostate are removed only. In case a surgeon doesnt remove any nerves, you have a good chance of restoring healthy erectile function. Keep in mind this may take a while.
Why Is There Less Blood Loss With Robotic
The use of the robotic equipment in surgery means a more precise and less disruptive dissection, which helps control potential sources of bleeding. Blood loss is also reduced because of the pressure generated by the gas used in inflate the abdomen during surgery, which provides surgeons with a better and more expansive view of the operating area around the prostate.
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