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What Happens When Prostate Removed

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What You Need To Know About Prostate Surgery

How Radiation Affects The Prostate | Mark Scholz, MD

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
  • 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.

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 p.m. the day before your surgery. If your surgery is scheduled for a Monday, theyll call you the Friday before. If you do not get a call by 7 p.m., 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 with a 4% CHG solution antiseptic skin cleanser.

  • Wash your hair with your usual shampoo and conditioner. Rinse your head well.
  • Wash your face and genital area with your usual soap. Rinse your body well with warm water.
  • Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
  • Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Do not put it on your face or genital area.
  • Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
  • Dry yourself off with a clean towel.
  • Do not use any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.

    Sleep

    Go to bed early and get a full nights sleep.

    Dealing With Prostate Cancer

    Being diagnosed and living with prostate cancer can change how you feel about life. If you or your loved one is dealing with prostate cancer you may feel scared, stressed or even angry. There is no right way to feel and everyone reacts differently.

    Visit our wellbeing hub for information to help support you in looking after your emotional, mental, and physical wellbeing. If you are close to someone with prostate cancer, find out more about how you can support someone with prostate cancer and where to get more information.

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    Three Common Prostate Problems

    Growing older increases the danger of prostate problems. The three most common problems in the prostate gland are prostatitis, benign prostatic hypertrophy, and prostate cancer.

    One change does not prompt another. For instance, having prostatitis or benign prostatic hypertrophy does not raise your risk of prostate cancer. Also, you can have more than one issue simultaneously.

    What Necessitates Prostate Removal

    Prostate surgery

    Prostate cancer and sometimes benign prostatic hyperplasia can necessitate the removal of prostate gland. However, the most common cause is prostatic cancer as BPH can nowadays be managed with other treatment options. The prostate gland removal surgery is known as prostatectomy. The risks, benefits and side-effects of prostatectomy should be discussed with the patient, before making the decision to get prostate gland removed.

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    What Happens After Radical Prostatectomy

    Patients are usually discharged within 24 hours of surgery after radical prostatectomy.

    You may have a drain that gets rid of excess fluid from the surgery site. If a drain is placed at the time of surgery, it is typically removed before you leave the hospital.

    A urinary catheter continues to drain your urine into a bag. You may need to leave the catheter in place at home for a few days to one week.

    What To Expect After Radical Prostatectomy

    Most men stay in the hospital for 1 to 3 days after radical prostatectomy. Your care team inserts a urinary catheter during the surgery, and some men may need to wear the catheter home for a few days to a few weeks. Another catheter inserted through the skin also may need to stay in place for a few days after returning home.

    Pain after radical prostatectomy can generally be controlled with prescription pain medicines. It can take weeks or months for urinary and sexual function to return to their maximum levels.

    After radical prostatectomy, itâs important to see your doctor for all your regular follow-up appointments to make sure your prostate cancer doesnât return.

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    Radical Prostatectomy Retropubic Or Suprapubic Approach

  • You’ll be positioned on the operating table, lying on your back.

  • An incision will be made from below the navel to the pubic region.

  • The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.

  • The prostate gland will be removed.

  • A drain will be inserted, usually in the right lower area of the incision.

  • What Happens Right After Prostate Surgery

    Radiation vs. Surgery for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

    After surgery, youll stay in the hospital for a day or two. You may feel sore, but nurses will encourage you to get up as soon as possible. Walking helps your body start to recover from the surgery and function normally again.

    Your doctor may prescribe pain medicine for a few days immediately following surgery. After that, youll switch to over-the-counter pain meds.

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    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.

    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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    Where Does Prostate Cancer Spread

    The most common place for prostate cancer to spread to is the bones. It can also spread to the lymph nodes, liver and lungs and other organs.

    A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.

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    Questions To Ask Your Doctor Or Nurse

    Robotic Radical Prostatectomy

    You may find it helpful to keep a note of any questions you have to take to your next appointment.

    • What type of surgery do you recommend for me and why?
    • What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
    • How many of these operations have you done and how many do you do each year?
    • Can I see the results of radical prostatectomies youve carried out?
    • What pain relief will I get after the operation?
    • How and when will we know whether the operation has removed all of the cancer?
    • How often will my PSA level be checked?
    • What is the chance of needing further treatment after surgery?
    • What is the risk of having urinary problems or erection problems and what support can you offer me?

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    Life After Prostate Cancer Treatment

    Adjusting to life after prostate cancer treatment can take time. For some men, the emotional impact of what they have been through may not hit them until they have finished treatment. For others, working through the physical side effects is their immediate focus.

    Although prostate cancer treatment can be lifesaving, it can also take a toll on the body. This can result in a disruption to normal urinary, bowel and sexual function.

    Whether you have surgery, radiation or hormone therapy, you are likely to have side effects.

    “It’s important to talk with your health care provider about these side effects before you start treatment, so you can learn about the range of options to treat them,” says Anne Calvaresi, DNP, CRNP, RNFA, Urology Nurse Practitioner at the Kimmel Cancer Center, Thomas Jefferson University in Philadelphia.

    Are There Things I Can Do To Help Myself If I Have Erectile Dysfunction

    Yes, there are changes you can make in your life that may help with your erectile dysfunction. Remember to speak with your doctor or healthcare team before making any of these changes.

    Some changes you may want to consider are:

    • Try to exercise on a regular basis.
    • Try to eat a healthy diet.
    • Drink responsibly. Long-term, heavy drinking lowers your ability to have an erection.
    • Try to lower your stress and fatigue . Being diagnosed with prostate cancer and working in all the changes it brings to your life can be stressful. Stress and the tiredness caused by your prostate cancer treatment, can make it difficult for you to get in the mood. Many men going through prostate cancer treatment feel this way. Talking with your partner might help lower your stress. You may also speak to your doctor or healthcare team about how you are feeling. They are there to help you through this time.
    • Stop smoking. Research studies show that smoking can harm your ability to have sex. If you need help to stop smoking, speak with your doctor or healthcare team.
    • Practice your Kegel exercises. Kegel exercises help strengthen your pelvic floor muscles, which support your bladder and bowel. These muscles also help with erections. For more information, please see the IMPACT booklet, Kegel Exercises for Men.

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    How May Erectile Dysfunction Affect My Sex Life

    Most men find that their sex life is different after prostate cancer treatment. Some men question their manliness when they cannot have an erection or find that they are not interested in sex. This can happen even if you are not currently in an intimate relationship. You may find this upsetting. Even if one of the medications or erection aids is helpful, having sex using these things may take some getting used to. It may not feel entirely natural. You can talk with your doctor or healthcare team about these feelings. Counseling may also help.

    If you have an intimate partner, it is important for you to talk to your partner about how you are feeling. There is an old saying that a problem shared is a problem halved. Not everyone wants a sexual relationship. Dont try to guess or assume what your partner wants. Have an open and honest discussion with your partner.

    This may seem unnecessary in long-term relationships as people tend to assume they know all there is to know about their partner but this is not always the case. With time, you and your partner may be able to find satisfying ways to have a sex life even though you have erectile dysfunction. Your partner will also have concerns about your sex life as well as concerns about your health. Talking about your feelings is very important during this time.

    Does Incontinence Go Away On Its Own After Prostate Surgery

    Robot-assisted Radical Prostatectomy (RARP)

    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.

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    The Success Rate Of Prostate Surgery

    Survival rates can tell you how many people with the same type and stage of cancer are still alive 5 years after being diagnosed. For example, if you have stage 3 colon cancer, there is a 66% chance that 5 years later, you will be alive. But the rates cannot tell you how long you will live. However, they may help give you an idea of how likely your treatment will be successful.

    Survival rates are estimates. They are based on data from many people who have had cancer before. These numbers might be confusing because they dont tell you what will happen, but they can help doctors decide treatments. Talk with your doctor to see if these statistics apply to you because they know about your situation.

    A relative survival rate tells how likely a person is to survive a particular type of cancer. I.e., if the 5-year close survival rate for prostate cancer is 90%, it means that men who have this type of cancer are about 90% as likely as other men to live a minimum of 5 years after being diagnosed with the disease.

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

    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.

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    How To Remove Prostate

    The process of removing your prostate gland is called a prostatectomy.

    A prostatectomy is a surgery where part of the prostate or all of the prostate is removed from your body. It may be done to treat cancer or something called benign prostatic hyperplasia.

    Common surgery for the prostate is to cut it out. There are two ways to do this. One way is through your lower abdomen, and the other one is right below your scrotum.

    Before you have a prostatectomy, you will need to get a prostate biopsy. It is usually done before the surgery. It will help your doctor know more about your prostate.

    How Soon After Prostate Cancer Treatment Can I Be Sexually Active Again

    TURP (Transurethral resection of the prostate)

    This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial methods like medicines or medical devices . If you were having problems having erections before treatment, this will not get better after treatment.

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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

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