What Is A Prostate Scrape

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

Prostatectomy for an Enlarged Prostate with Urologist Dr. Michael White

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.

Home Care After Surgery

Removing extra prostate tissue should help you urinate more easily and less frequently. Still, it may take a few weeks for you to recover fully. Most men who have this surgery are back to their regular activities in six to eight weeks.

While you recover, you may have:

an urgent need to urinate
trouble controlling urination
problems getting and keeping an erection
small amounts of blood in your urine

These surgery side effects should subside in time. Tell your doctor if youre still having problems several weeks after surgery.

Getting Ready For The Operation

If you smoke, try and cut down or preferably stop, as this reduces the risks of heart and chest complications during and after the operation. If you do not exercise regularly, try and do so for at least half an hour per day e.g. brisk walk or swimming.

You will be given a form to have routine pre operative blood tests and a urine test to exclude infection before your surgery if you have lost your a form please contact Dr Nathans rooms.

If you are on medication to thin the blood such as warfarin, aspirin, Plavix, Iscover, Brilinta, Pradaxa, Xarelto or supplements such as fish oils please let Dr Nathan know at least 2 weeks before surgery as these medications may need to be discontinued to prevent excessive bleeding at the time of surgery. You can continue to take your other medications as normal.

Speak to the anaesthetist about your anaesthetic

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What To Expect During Cystoscopy

The procedure generally takes about 15 to 20 minutes.

Youâll need to pee first. The test is done with an empty bladder.
Youâll lie down. The position depends on the type of scope your doctor uses:
Standard rigid cystoscope. Youâll lie on your back with your knees up and apart. Your feet will probably be in stirrups.
Flexible cystoscope. No special position is needed. The doctor will help you find a comfortable position.

Youâll get medicine. You might get a drug to make you sleepy. The doctor will call this a sedative. Or you could get a general anesthetic to help you sleep through the entire procedure.

Your doctor inserts the scope. Theyâll clean your urethra and numb the area. The scope goes through the urethra and into your bladder. Theyâll use the smallest scope possible. They might need to use a bigger one to take samples or bring surgical tools into your bladder.

The doctor examines your urethra and bladder. The cystoscope has a lens on the end that works like a telescope. It makes it easier for the doctor to see inside your body. They might put a video camera over the lens to project images onto a screen.

The doctor fills your bladder. They put water or saline in through the cystoscope. When your bladder is full of water, it stretches. This lets the doctor see your entire bladder wall. Theyâll ask you how it feels when itâs full.

When To See A Doctor

Most people begin to feel better and have an improved urine flow within 4 to 6 weeks after TURP surgery.

Overall, the risk of serious complications after TURP surgery is quite low. But as with all surgeries, there are some potential health risks associated with the procedure that require medical attention and intervention.

Reasons to seek medical attention after TURP surgery include:

bleeding from the urethra, outer prostate, or penis
inflammation and pain in the urethra, prostate, or penis lasting longer than 2 weeks or worsening
reduced urine flow or urinary symptoms, such as incontinence or urinary urgency 6 weeks post-surgery
blood in the urine that is severe or lasts longer than 4 to 6 weeks
severe clots of blood in urine or urine that is entirely red
weakness and fatigue that does not improve after 4 weeks
impotence or erectile dysfunction

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What Are The Risks

In most cases, TURP is a safe procedure and the risk of serious complications is very small.

However, many men who have a TURP lose the ability to ejaculate semen during sex or masturbation, although they still have the physical pleasure associated with ejaculation . This is known as retrograde ejaculation.

Many men also temporarily lose the ability to control their bladder , although this usually passes in a few weeks. In rare cases, it may be persistent and need further treatment.

There’s also a small risk of problems such as erectile dysfunction, difficulties passing urine and urinary tract infections .

How Do I Prepare For My Turp

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for TURP by:

Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a , EKG , blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen , and blood thinners.

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctors office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

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Prevention Of Prostate Cancer

Researchers and urologists advise certain prevention techniques to reduce the risk of prostate cancer. These areas are mentioned below.

A healthy diet involving a variety of colorful fruits and vegetables to provide anti-oxidants, which prevent the production of cancerous cells in the body
Exercising regularly or frequently every week to sustain a healthy blood flow
Avoiding sedentary lifestyles

How Does The Procedure Work

PROSTATE SURGERY TURP

After anesthesia, a surgeon will insert a tool called a resectoscope into the urethra. In some cases, a separate device will be used to flush sterile fluid through the surgical site.

Once the surgeon has positioned the resectoscope, they will use it to cut away abnormal prostate tissues and seal broken blood vessels.

Finally, the surgeon will insert a long plastic tube called a catheter into the urethra and flush destroyed prostate tissues into the bladder where they are excreted through urine.

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Are There Differences Between Orp Lrp And Ralrp

According to a 2010 of different surgery types for prostate cancer, the outcomes for open radical prostatectomy , laparoscopic , and robotic-assisted prostatectomy are not significantly different.

But people who choose LRP and RALRP may experience:

less blood loss
shorter hospital stay
faster recovery time

Also, people who choose RALRP report faster recovery in continence and decreased hospital stay, in comparison to LRP. But the overall outcomes still depend on the surgeons experience and skill.

What Is A Cystoscopy

A cystoscopy is a test to check the health of your urethra and bladder. You might also hear it called a cystourethroscopy or, more simply, a bladder scope.

Itâs an outpatient test, which means you can get it at your doctorâs office, a hospital, or clinic and go home the same day. The doctor inserts a tube into your urethra. If youâre a man, the opening is at the end of your penis. If youâre a woman, itâs just above your vagina. The test lets your doctor check the complete length of your urethra and the bladder for polyps, narrow areas called strictures, abnormal growths, and other problems.

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What Happens During Turp

TURP requires a hospital stay. Procedures may vary depending on yourcondition and your healthcare providers practices.

Generally, a TURP follows this process:

You will be asked to remove any jewelry or other objects that might get in the way during surgery.

You will be asked to remove your clothing and will be given a gown to wear

You’ll be asked to empty your bladder.

An IV line will be put in your arm or hand.

You will be positioned on an operating table, lying on your back.

You will be given anesthesia to put you to sleep for the procedure. Your legs will be placed in stirrups.

Your heart rate, blood pressure, breathing, and blood oxygen level will be monitored during the surgery.

Once youre sedated, a breathing tube may be put through your throat into your lungs and you will be connected to a ventilator. This will breathe for you during the surgery.

The surgeon may first inspect the urethra and bladder with an endoscope. This is done by passing the scope through the tip of the penis, then into the urethra and bladder. This allows the healthcare provider to examine these areas for any tumors or stones in the bladder.

Next, the resectoscope is passed into the urethra. It is used to cut away the pieces of prostate tissue that are bulging or blocking the urethra. Electricity will be applied through the resectoscope to stop any bleeding. The pieces are flushed into the bladder, and then drained out through the urethra.

The resectoscope is removed.

Why Might I Need Turp

TURP is most often done to relieve symptoms caused by an enlarged prostate.This is often due to benign prostate hyperplasia . BPH is not cancer.It is a common part of aging. When the prostate gland is enlarged, it canpress against the urethra and interfere with or block the passage of urineout of the body.

Sometimes a TURP is done to treat symptoms only, not to cure the disease.For example, if youre unable to urinate because of prostate cancer, butsurgery to remove the prostate isnt an option for you, you may need aTURP.

There may be other reasons for your healthcare provider to recommend aTURP.

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What Is A Common Misconception You Find In Patients Regarding Complications That Might Occur After Prostate Cancer Surgery

I have found that patients often misunderstand the real meaning of percentages doctors give them about the likelihood of recovering their function. A patient might be told that their chance for recovery of erections is 75 percent. A lot of patients interpret that as meaning, I have a 75 percent chance of returning to my baseline function. It actually means 75 percent of patients will be able to get a functional erection, often with the aid of a pill. Unless the doctor makes this clear to them, many patients will be disappointed. When a percentage is quoted, patients should ask their surgeons what it actually means because as is usually the case the devils in the details.

Transurethral Electro Resection Of The Prostate

Removing the enlarged part of the prostate is usually the best long-term treatment for an enlarged prostate gland. The portion of the gland that is not squeezing the urethra stays in place. The outside capsule around the gland is also untouched.

Transurethral electro-resection of the prostate is the traditional way to remove prostate tissue using minimally invasive surgical techniques. No outside incision is needed. There’s less pain, fewer complications and faster healing.

With TURP, an instrument called a resectoscope is inserted through the penis. This device is about 12 inches long and half an inch around. It has a light, valves for controlling irrigating fluid and an electrical loop that cuts tissue and seals blood vessels. During the surgery, the surgeon uses the wire loop to remove the tissue one piece at a time. The pieces are carried by the fluid into the bladder and then flushed out at the end of the operation. The surgery lasts about 90 minutes.

Is A Cystoscopy Painful

You may feel discomfort when the cystoscope goes into the urethra and bladder. Youâll probably feel a strong need to pee when your bladder gets full. You may feel a slight pinch if the doctor takes a biopsy.

After the procedure, your urethra may be sore and it might burn when you pee for a day or two.

How Is A Turp Performed

Robotic Prostate Surgery vs. Standard Prostate Surgery | Ask a Prostate Expert, Mark Scholz, MD

The operation is performed under general or local anaesthesia. It is performed through a telescope passed up the pipe of the penis, and therefore there are no external cuts or scars. An electrical loop is used to cut away small parts of the central portion of the gland, until there is a wide cavity with no obstructing tissue. The pieces of the prostate are sent away to the pathologist for examination. When I have finished the operation, I pass a catheter in to the bladder, which drains the urine and helps to wash away any blood. This catheter stays in for 24-48 hours.

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Other Surgical Procedures For Prostate Disease

Alternative surgical procedures to TURP include:

open enucleative prostatectomy this involves making a cut in the abdomen to remove a very enlarged prostate. This is the least common form of surgery. The average hospital stay is seven to 10 days
laser TURP a laser is used to remove prostate tissue from the middle part of the prostate, which has the advantage of less bleeding and therefore safer for people on anti-coagulation therapy for other problems, including coronary stents, heart valve or vascular disease
transurethral incision of the prostate similar to TURP except that no prostate tissue is taken out. One to three cuts are made in the prostate near the bladder neck to release the ‘ring’ of enlarged tissue and make a larger opening around the urinary tract
UroLift® this technique is useful for men for whom medication has not been successful but their prostates are not so enlarged that they need a TURP. It involves the transurethral insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.

When You Meet With Patients Who Have Opted For Prostate Cancer Surgery What Complications Seem To Cause The Most Anxiety

Patients are usually concerned about longer-term quality-of-life issues, such as urinary control also called urinary continence and changes in sexual function. Prostate cancer surgery does sometimes have a negative impact on these functions, although the likelihood depends on a variety of factors, including age, the extent of the cancer, and baseline function, or how well everything worked before the procedure.

The outcomes for urinary continence at MSK are what I would consider to be excellent. More than 90 percent of our patients will regain urinary control, although they may go through a period perhaps several months or a year after surgery in which they do not have complete control.

For sexual function, the extent of recovery is especially affected by the nature of the cancer. Unfortunately, the nerve tissue that allows a man to get an erection is right up against the prostate. We obviously want to remove all the disease, and if the cancer extends outside the prostate at all, its not wise for us to try to preserve the nerve tissue because we might leave some cancer behind.

You often see claims made by institutions or surgeons that the patients they treat recover their erectile function in 90 percent of cases. Thats true only for a very select group of patients, usually those who are younger and had full erections prior to surgery.

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What Is The Prostate

The prostate gland is a part of the male reproductive system. Its main role is to produce semen, the fluid that carries and protects sperm. It is about the size of a walnut and sits just below the bladder in men.

The prostate is surrounded by the upper part of the urethra, the thin tube that carries urine from the bladder to the penis. It also carries semen from the prostate and sperm from the testicles to penis during ejaculation.

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