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What Are The Side Effects Of Robotic Prostate Surgery

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Risks Of Prostate Surgery

Robotic Assisted Laparoscopic Radical Prostatectomy | Brigham and Women’s Hospital

The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:

  • Reactions to anesthesia
  • Blood clots in the legs or lungs
  • Damage to nearby organs
  • Infections at the surgery site.

Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.

If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.

In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.

Past Work Experience :

Clinical Fellowship in Endourology and Robotic Surgery Urology Centre of Excellence, Jackson Health System, Miami, Florida, USA
6th January 2005- 5th January 2008 DNB Urology Indraprastha Apollo Hospital, Sarita Vihar , New Delhi, India
1st October 2001-30th September 2004 M.S. General Surgery B.L.D.E.As Shree B.M. Patil Medical College, Bijapur, Karnataka, India
R.G.KAR Medical College, Calcutta, West Bengal, India

Who Should Get A Radical Prostatectomy

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

Before doing a radical prostatectomy, doctors first try to confirm that the prostate cancer has not spread beyond the prostate. They can figure out the statistical risk of spread by looking at tables comparing the results of a biopsy and PSA levels.

Other tests to check for signs of spread, if needed, can include CT scans, bone scans, MRI scans, ultrasound, PET scans, and bone scans.

If it appears that the prostate cancer hasnât spread, your surgeon may first offer you other options besides surgery. These can include radiation therapy, hormone therapy, or simply watching the prostate cancer over time, since many prostate cancers grow slowly.

Depending on how high your risk of the cancer spreading is, your surgeon may also consider doing an operation called pelvic lymph node dissection.

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Disadvantages And Side Effects Of Robotic Prostate Surgery

Disadvantages or robotic prostate surgery include that the machine has no sense of touch, and so when the surgeon pushes on a tissue, it does not push back as it would if they were holding the instruments. With experience, the surgeon can compensate for this by watching the tissue and its response to movement.

A robotic prostate surgery system is very expensive, both to buy initially and to maintain. Each time a surgical operation is performed, many of the instruments must be thrown out and replaced, again increasing cost.

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Caring For The Incision

Prostate Cancer Surgery Images

You will be able to take a shower the second day after your surgery. You may continue to have some discharge at the drain site for three to five days. Once you leave the hospital, the key words on caring for the drain site and incisions are clean and dry. Showering once a day and gently patting the area with a clean towel should be sufficient.

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How Does The Robotic

It is similar to the conventional, minimally invasive laparoscopic prostatectomy. However, working from a special console in the operating room, the surgeon operates four precision-guided robotic arms to cut and remove the prostate. The procedure uses a small video camera, inserted through a keyhole-sized incision to provide surgeons with magnified, 3-D images of the prostate site. This expansive view allows doctors to see the nerve bundles and muscles surrounding the prostate. The robotic arms, with full 360-degree rotation capabilities, are placed through several other keyhole incisions allowing surgical instruments to move with greater precision, flexibility and range of motion than in a standard laparoscopy.

The procedure usually takes 2 to 3 hours under general anesthesia. Most patients experience only a small blood loss and blood transfusions are needed in less than one percent of patients. Prostatectomy patients typically spend one night in the hospital and are usually discharged as soon as their laboratory tests are acceptable, pain is controlled and they are able to retain liquids. Patients are discharged with special catheter, which is removed during an outpatient visit 5-7 days after the operation.

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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.

An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.

A bacterial infection can also lead to prostate issues. Acute bacterial infections can be hard to treat. Some men with a bacterial infection may need to take antibiotics to prevent or treat symptoms. Symptoms of the disease include fever and chills, pain in the lower back and the tip of the penis. Some men may have blood in the urine, frequent urination, and blood in the urine. If you suffer from acute bacterial prostatitis, a medical professional should be able to prescribe you the appropriate treatments to prevent the disease.

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Pelvic Radiation Therapy Effect On Erections

Prostate, bladder, colon, and rectal cancer are sometimes treated with radiation to the pelvis. This can cause problems with erections. The higher the total dose of radiation and the wider the section of the pelvis treated, the greater the chance of erection problems later. If radiation therapy is part of your treatment plan, talk to your doctor before it starts. Ask how your arteries and nerves might be affected by radiation therapy so you know what to expect.

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What You Need To Know About The Prostate Robotic Prostate Surgery Side Effects

What is a radical prostatectomy? | Ask a Nurse

The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

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Outcomes And Clinical Benefits Include:

  • Same cancer cure rate as traditional surgery
  • Shortened physical recovery
  • Highest cure rates compared to other treatments
  • Improved functional recovery of bladder control and sexual function
  • Best possible way to know the full extent of the cancer
  • Assessment of local/regional lymph nodes to check for cancer spread

What Have I Learned By Reading This

You learned about:

  • Why prostate cancer treatment can cause erectile dysfunction
  • What can be done about erectile dysfunction
  • How erectile dysfunction may affect your sex life
  • What your partner can expect

If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.

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Robotic Radical Prostatectomy Versus Laparoscopic Or Open Surgery

Robotic radical prostatectomy offers significantly lower operative times and blood loss than laparoscopic or open surgery. Catheterization times and hospital stay are also superior to those associated with open and laparoscopic approaches. The learning curve is less with robotic assistance compared with laparoscopy. The one significant question that remains unanswered pertains to the cost-effectiveness of robotic prostatectomy compared with open and laparoscopic radical prostatectomy.

A randomized controlled phase 3 study by Yaxley et al that compared robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy reported that both techniques had similar functional outcomes at 12 weeks. Urinary function scores and sexual function scores were not significantly different between these two groups at 6- and 12-weeks post-surgery.

Early functional results are are summarized in Table 4 below.

Table 4. Outcomes of Functional Parameters Using Robotic Radical Prostatectomy

Series

Badani et al

2766

Ahlering et al

96% at 6 mo

IIEF = International Index of Erectile Function.

Preliminary results from the above series show that oncologic and functional results following robotic prostatectomy compare very favorably with those of either open or laparoscopic radical prostatectomy. The margin rates and rates of prostate-specific antigen recurrence are similar, but potency and continence rates are better than those of open and laparoscopic approaches.

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What are some radical prostatectomy side effects?

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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Difficulty Getting An Erection

You might have problems having an erection after a radical prostatectomy. This is impotence. Or you might produce less or no semen. This is known as a dry orgasm.

Impotence is more likely to happen if you are older. Nerve sparing surgery and robotic surgery may reduce the risk for some men. Speak to your doctor before you have surgery to get an idea of your risk of problems afterwards.

There are medicines that can help with erection problems after surgery. You might need a drug like sildenafil or Viagra to help you get an erection. Your doctor or specialist nurse can also refer you to a clinic for people who have sexual problems after treatment. You can store sperm before your operation if you would like to have children in future.

Coping With The Side Effects

The side effects of both surgery and radiation can vary from mild to more severe and potentially significantly impact someones life.

The side effects of urinary and bowel problems can be distressing. There are ways to help manage these, such as with pelvic floor exercise, bladder training, and incontinence products. Other coping strategies include:

  • Urinating every few hours
  • Limiting caffeine intake
  • Talking to your healthcare team about any medications or other interventions that may be helpful

Sexual dysfunction related to prostate cancer treatment can also be an unwelcome side effect. Helpful ways to cope with this can include:

  • Having open communication with your partner
  • Prioritizing activities for the day and taking breaks as needed

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Types Of Prostate Surgery

There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.

Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.

The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.

Keyhole surgery

Keyhole surgery .

  • Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
  • Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.

Open surgery

What Are The Benefits To A Patient

Prostate Surgery Side Effects

The surgery usually includes removing the prostate, seminal vesicles and ends of the vas deferens. For intermediate and high-risk patients, the pelvic lymph nodes are also removed. Patients typically experience significantly less pain and less blood loss than those undergoing conventional open incision procedures. Patients also tend to enjoy quicker recovery times. A traditional, open radical prostatectomy requires two days hospitalization and recovery lasting about 2 months. With robotic-assisted surgery, the recovery time is as little as 2-3 weeks. Depending on age and health, most patients can also expect to have their potency return with or without the use of oral medications.

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About Dr Ashish Sabharwal: Prostate Cancer Specialist In India

Dr Ashish SabharwalMBBS, MS , DNB Urology.Fellowship in Endourology and Robotic Surgery

Present Position:Senior consultant urologist ,Andrologist and Robotic surgeonIndraprastha Apollo Hospital, Sarita Vihar, New Delhi -110076Department Of Urology and Robotic SurgeryGate 10, room 1003Patient coordinator : Mr Anand: +91 99583 37075

What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible

There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.

For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.

These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.

Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.

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Risks And Side Effects Of Turp

TURP can cause long-term problems with ejaculation, orgasm, erection, and infertility.

Semen may flow backward into the bladder, a condition termed retrograde ejaculation, or dry orgasm. Retrograde ejaculation may affect up to 6575% of males who have undergone TURP, according to the National Health Service .

Retrograde ejaculation can also make orgasm feel different or less pleasurable. It also reduces fertility.

TURP has variable effects on erectile dysfunction. In a small study involving 264 men who underwent TURP, 5.8% of the 109 men who had good erectile function before TURP reported worsening erectile function afterward. However, of the 136 men who reported mild to moderate erectile dysfunction before surgery, 16.2% reported an improvement afterward. Other research indicates permanent erection problems are rare.

Other potential problems with TURP include:

  • damage to the urethra or bladder
  • transurethral resection syndrome, a concerning but uncommon complication
  • scar tissue on the urethra, which makes it harder to urinate and requires additional surgery
  • , which may subside in the weeks following surgery

Transurethral Resection Of The Prostate

da Vinci® Robotic Prostatectomy Prostate Cancer Treatment

This operation is more often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia . But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.

During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra . The skin is not cut with this surgery. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia or general anesthesia is used.

The operation usually takes about an hour. After surgery, a catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.

You will probably have some blood in your urine after surgery.

Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.

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