What Is Involved In Prostate Surgery

What To Expect The Day Of Your Prostate Surgery

In general, this is what happens the day of your surgery:

• For hospital or surgical center procedures, a surgical team member will transport you to the operating room.

• Youll receive an intravenous line to provide you with fluids and medications as necessary.

• You will receive a sedative to help you sleep. If you are having a general anesthetic, you may have a tube placed in your throatin your trachea. The tube attaches to a ventilator to help you breathe throughout the surgery.

• The surgeon will make the incision or perform a transurethral procedure.

• You will have a urinary catheter inserted just prior to surgery.

• You may also have a drain in your incision that will draw out fluid from the wound.

• If you received a general anesthetic, you will wake in the recovery room.

• With minimally invasive procedures, most people go home the same day after the sedative has worn off.

Good Prostate Cancer Care

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

During Surgery For Bph

The vast majority of BPH surgeries are performed using a transurethral technique, of which there are several types. With each, a tube-like instrument called a cystoscope or resectoscope reaches the prostate gland via the urethra.

Some transurethral techniques include:

• Transurethral resection of the prostate : An electrified wire loop is used to remove prostate tissue. This is the most common surgery used to treat BPH.
• Transurethral electrovaporization of the prostate : Electrical energy applied through an electrode is used to heat and vaporize an area of enlarged prostate tissue.
• Transurethral incision of the prostate : No prostate tissue is removed, but two deep cuts are made starting in the bladder neck . The purpose of these cuts is to widen the urethra in order to improve urine flow.
• Laser energy is used to vaporize prostate tissue.
• Laser enucleation of the prostate: A holium or thulium laser is used to remove large chunks of excess prostate tissue that is blocking urine flow.
• Prostate urethral lift: Implants are placed in the prostate to lift the prostate and keep the urethra open.
• Prostate water vapor therapy: Targeted, controlled doses of stored thermal energy in water vapor are used to decrease prostate tissue.

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Recovering From Prostate Surgery

To treat prostate cancer, doctors perform tens of thousands of surgeries each year. In recent years, one procedure called a radical prostatectomy has become a fine art, says J. Brantley Thrasher, MD, a professor of urologic surgery at the University of Kansas Medical Center in Kansas City. While side effects like incontinence and impotence are still major concerns, most patients respond well to the surgery, Thrasher says.

In fact, many men respond almost too well. They feel so good after the surgery that they start to push themselves too hard, he says. One of his recent patients went on a two-mile jog while still wearing a catheter. I told him he needed to slow down and rest for a while.

If you have a radical prostatectomy in your future, youll want to know what to expect. Heres a closer look at this procedure. As youll see, your life wont necessarily take a turn for the worse after prostate surgery. In fact, it just might get better.

Why do surgeons perform radical prostatectomies?

According to the Food and Drug Administration, radical prostatectomy is considered to be the most definitive treatment for many men with prostate cancer, a disease that kills about 30,000 American men each year. Depending on their age and the stage of their cancer, however, some men do well with a less invasive treatment.

How should I prepare for surgery?

What happens during a radical prostatectomy?

What will happen during recovery in the hospital?

References

Side Effects Of Prostate Surgery And Radiation: What You Need To Know

Prostate cancer treatment options include open or robotic radical prostatectomy, radiation with external beam radiation and/or brachytherapy, also known as radioactive seed implantation, and high intensity focused ultrasound, also called HIFU. Prostate surgery side effects and prostate radiation side effects, in addition to erectile dysfunction, include the following:

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What Happens Before Radical Prostatectomy

Before radical prostatectomy, your provider will ask you about your health history. Youll also need to tell your provider what drugs and vitamins you take. You may need to stop taking some of your medications a few days before your surgery, especially drugs that cause blood thinning.

Your hospital will give you specific instructions, including how long before your surgery to stop eating and drinking.

To check your health before your procedure, you also may need:

• Prostate ultrasound and biopsy.

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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What Are The Risks And Potential Complications Of Prostate Surgery

All surgical procedures have a risk of complications. The general risks of surgery include:

• Anesthetic reaction

• Bleeding, which can be extensive with some open procedures

• Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs causing a pulmonary embolism.

• Confusion or delirium from the anesthesia, particularly among older men

• Damage to nearby organs

What Is The Life Expectancy After The Removal Of The Prostate Gland

Prostate removal prolongs life with about three years in men with prostate cancer. However, prognosis depends on many factors. A doctor should know the patients medical history in detail and put this information together with survival statistics in order to offer an informed answer.

Option treatments have evolved over the years and life after prostate removal is now associated with less complications and a higher success rate.

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Caring For Your Incision

The incision runs from above the base of the pubic area to below the navel. It is important to keep it clean and dry. Showering once a day should be sufficient. If you notice extreme or increasing tenderness, progressive swelling, more than a small amount of drainage or any pus or redness, notify your doctor right away.

* Minimal Blood Loss With Da Vinci Robotic

The average estimated blood loss per patient averages 116 cc. This volume is roughly the 1/3 of the volume of a 12 oz. soda can. Estimated Blood loss has ranged for robotic patients from 25cc to a maximum of 400 cc in the 1st 100 patients. Because of these low blood losses, none of these men required a blood transfusion, nor were they asked to donate autologous blood prior to surgery.

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Caring For The Incision

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.

What Happens During A Simple Prostatectomy Procedure

During open surgery, your surgeon will cut one large incision below your belly button and above your pubic bone. Robotic surgeries use several small incision ports on various parts of your lower abdomen.

In both open and robotic simple prostatectomy procedures, you will be put under general anesthesia while your doctor removes the part of your prostate that is putting pressure on your urinary tract and blocking the flow of urine.

After your simple prostatectomy surgery is complete, you might have other drainage tubes inserted into your bladder or near the part of your prostate that was removed. You will be given medication to control any pain and asked to walk and do simple bed exercises during your hospital stay.

Before you are sent home, the drainage tubes that were inserted after the surgery will be removed. It can take some time to regain your urinary control, so you will be sent home with a catheter. Many men need to use the catheters for about a week after surgery.

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Advantages And Disadvantages Of Prostate Surgery

Advantages

• Surgery will completely remove the cancer if it is only in the prostate gland.
• The prostate can be removed and be fully analysed and staged in the laboratory.
• The success of the treatment can be easily assessed by PSA testing.
• If the PSA were to rise after surgery you would still be able to get other treatments like radiotherapy or hormone treatment.

Disadvantages

It involves a general anaesthetic and the usual risks you would expect with surgery, like the risk of bleeding, infection and blood clots.

• You will have to stay in hospital for a few days.
• You may get side-effects afterwards like problems with erections and urinary incontinence.
• Recovery takes around 6 weeks.

Frequent Urination And Urgency After Greenlight Laser

Frequent urination and urinary urgency after Greenlight laser often occur immediately after surgery. These symptoms should dissipate fairly soon, typically in the first 4-8 weeks. The persistent or worsening urinary frequency may indicate incomplete bladder emptying or underlying partial urinary retention. Persistent or worsening urinary symptoms may also indicate the presence of urethral stricture. In men who had a large median lobe these symptoms may be a result of irritability of the bladder trigone that can occur after surgery.

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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.

Benign Enlarged Prostate: What Are The Pros And Cons Of Surgery

Surgery can very effectively reduce the problems associated with a benign enlarged prostate. It is considered if other treatments don’t provide enough relief, or if the enlarged prostate keeps causing medical problems such as urinary tract infections. But surgery often has side effects.

Most men who have a benign enlarged prostate aren’t in urgent need of surgery. They can take their time to carefully consider the pros and cons. There are various possible reasons for deciding to have surgery. For instance:

• The prostate-related problems may be very distressing, and other treatments may not have led to a big enough improvement.
• The enlarged prostate may frequently cause other medical problems, such as recurring urinary tract infections or bladder stones.
• Treatment with medication may not be possible for medical reasons.

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Prior Prostate Surgery Or Bowel Resection

A patient with multiple prior bowel resections may be at risk for developing chronic diarrhea or even short bowel syndrome after an additional 45 to 60cm of small bowel is resected. In these patients, alternatives to orthotopic diversion such as a sigmoid neobladder might be entertained. In general, prior bowel resections can be managed by carefully dissecting out all of the small bowel, taking down any adhesions before performing the diversion.It is critical to identify the old bowel anastomosis and, whenever possible, take it down and use that site as one end of the continent reservoir. This avoids potential devascularization of the bowel segment between the old and new bowel anastomoses.

What Is Robotic Prostate Surgery

A surgical treatment for prostate cancer, the radical prostatectomy procedure removes the entire prostate gland. Radical prostatectomy can now be done by laparoscopic or robotic techniques. In open prostate surgery, the prostate gland is removed through a larger incision in the lower abdomen. Laparoscopic prostate surgery involves key-hole incisions which used for inserting a lighted viewing instrument into the pelvic region and allows examination and removal of the prostate without a large abdominal incision.

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Do Laser Treatments Have Any Advantages Over Turp

As well as the standard approaches such as TURP, there are a number of other surgical techniques. They mainly differ in terms of the instruments and sources of energy used to remove or destroy the prostate tissue. Most of the other techniques are carried out using laser beams. Like in TURP, the instruments are inserted into the urethra and guided to the prostate.

The laser treatments include:

• Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995 332: 75-79.

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  Because IQWiG is a German institute, some of the information provided here is specific to theGerman health care system. The suitability of any of the described options in an individualcase can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by ateam ofhealth care professionals, scientists and editors, and reviewed by external experts. You canfind a detailed description of how our health information is produced and updated inour methods.

Fast Facts On Bph Surgery:

• Surgery is rarely the first line of treatment for BPH.
• A doctor who specializes in the urinary tract does most TURP surgeries.
• TURP is considered a fairly safe, effective procedure for treating BPH.

According to the American Urological Association, transurethral resection of the prostate or TURP is the most common type of surgery used to treat BPH. Every year, doctors perform it on around 150,000 American men.

Surgeons perform most TURP procedures when the patient is under general anesthesia and unconscious or asleep.

Alternatively, they use spinal anesthesia, where a needle is placed in the spine to stop any sensation below the waist.

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Mistakes When Removing The Prostate

Other errors relate to how doctors perform surgery. Doctors have several methods for removing a prostate:

• Open surgery, where the surgeon cuts into the abdomen to reach the prostate
• Laparoscopic surgery, where small holes are created in the abdomen
• Transurethral resection, where the surgeon reaches the prostate via the urethra

The correct choice of procedure depends on many factors, such as the size of the prostate. When it is too large, transurethral resection makes less sense and can, in fact, lead to injury.

A careless surgeon could also damage nerves and fail to sterilize a wound. Some complications, such as incontinence, are commonat least initiallythough they should clear up after a month or two. But infections and permanent erectile dysfunction could stem from surgical error.

Prostatectomy: What To Expect During Surgery And Recovery

If youve been diagnosed withprostate cancer, your doctor will consider many factors before recommending the besttreatment. For many men, that may mean a prostatectomy. In this surgery,doctors remove the entire prostate.

The Johns Hopkins Hospital performs more of these procedures than almostanywhere else in the world. One of the most common questions they hear frompatients: What should I expect after surgery?

Johns Hopkins urologistMohamad Allaf, M.D., explains the surgery and recovery.

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Why Is Radical Prostatectomy Done

Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.

For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:

Changes In Your Sex Life

Most men experience some decline in erectile function after their prostate is removed, but this can be managed. It can take six months or even up to a year for the affected nerves to recover from surgery. But with proper therapy and treatment, most patients can have good erectile function again, says Dr. Fam.

Treatment options include:

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

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