Learn The Function And Location Of The Prostate
The prostate is a gland found only in men. Understanding the location and function of the prostate is key to explaining symptoms of prostate cancer and other non-cancerous conditions that can effect the prostate function. The prostate is located just beneath the bladder, between the penis and rectum, The urethra tube runs out of the bladder, through the center of the prostate, then to the penis, providing the path for urination. In aid of reproduction, prostate muscles help to expel sperm from the body while secreting seminal fluids that protect and nourish the sperm. Incontinence or sexual dysfunction can sometimes be caused by prostate cancer and even treatment for prostate cancer.
The prostate cells produce an enzyme named Prostate Specific Antigen or PSA, found in a man’s blood. PSA is produced exclusively by prostate cells. Elevated levels of the PSA enzyme can be helpful in diagnosing issues with the prostate, like cancer or infection. These elevated levels of PSA can be detected with a simple blood test. For more information, visit our page on PSA.
The prostate cells produce an enzyme named Prostate Specific Antigen or PSA, found in a man’s blood. PSA is produced exclusively by prostate cells. Elevated levels of the PSA enzyme can be helpful in diagnosing issues with the prostate, like cancer or infection. These elevated levels of PSA can be detected with a simple blood test. For more information, visit our page on PSA.
Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
What Sexual Side Effects Are Possible After Robotic And Laparoscopic Prostate Surgery
Laparoscopic and robotic prostate surgery are highly precise in their ability to spare the nerve bundle responsible for erections.The degree of sexual function after radical prostatectomy is determined by many factors. These include the man’s age, how sexually active he was before the procedure. Most men experience at least temporary erectile problems after a radical prostatectomy. Our recently demonstrated 82% potency rate at 1 year following “energy-free” laparoscopic radical prostatectomy in patients with excellent preoperative erections is amongst the best in the literature.
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Providing Your Medical History
At first, the doctor will probably ask you about your medical history. Do you have any chronic illnesses? What illnesses and operations have you had in the past? What medications are you taking, if any? Your doctor is also likely to ask about your psychological well-being and lifestyle: Do you suffer from depression? Are you under a lot of stress? Do you drink alcohol? Smoke? Use illegal drugs? Have you felt a loss of affection for your partner? Have you recently grown interested in a new partner?
As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began. Your doctor might want to know how often you had sex before the problem started and if there have been weeks or months in the past when youve had erectile dysfunction. Your doctor may conduct a written or verbal screening test.
If the cause is clear a recent operation for prostate cancer, for example the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing.
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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What Are The Benefits To Patients Who Have Laparoscopic And Robotic Prostate Cancer Surgery
The benefits are similar between robotic and laparoscopic prostate surgery. Patients are usually able to go home the day after prostate surgery, and can return to daily living activities as early as 7-10 days after surgery. Patients undergoing open surgery generally have 4-6 weeks before they can resume routine daily living activities, generally experience less post-operative pain and discomfort and have a faster recovery. They also experience significantly less intraoperative bleeding. Robotic and laparoscopic prostatectomy uses small incisions and is highly precise the risk of incontinence is low and the surgical technique is continuously refined to improve potency.
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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What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy
Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeon’s sophisticated maneuvers.
Who Should Undergo Radical Prostatectomy
Men younger than age 75 with limited prostate cancer who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.
Before performing radical prostatectomy, doctors first try to establish that the prostate cancer has not spread beyond the prostate. The statistical risk of spread can be determined from tables comparing the results of a biopsy and PSA levels. Further testing for spread, if needed, can include CT scans, bone scans, MRI scans, and ultrasound.
If it appears that the prostate cancer has not spread, a surgeon may first offer other options besides surgery. These can include radiation therapy, hormone therapy, or simply observing the prostate cancer over time, since many prostate cancers grow slowly. Depending on how high the risk of cancer spread, pelvic lymph node dissection may be considered, as well.
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Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
Prostate Surgery: What To Expect On The Day Of Surgery
There are a few prostate surgery types and techniques, and what you can expect from your procedure depends on which one your surgeon uses. An incision may or may not be required all, some, or none of prostate gland may be removed and some surrounding tissue may or may not be excised as welljust to name a few differences.
The choice in prostate surgery largely comes down to whether you are having it to treat prostate cancer or the urinary symptoms or complications of an enlarged prostate, a.k.a. benign prostatic hyperplasia .
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Robotics Hold Promise But Risky Today
Men facing radical prostatectomy may like the idea of having it done with state-of-the-art robotic technology. And indeed, minimally invasive prostatectomies typically result in smaller incisions, less blood loss and quicker recovery. But get ready, this is a big one it also carries a higher risk for very unappealing complications, including erectile dysfunction. Any man considering this procedure should be aware that the trade-off can be considerable, especially since the newest version of the high-tech procedure is being aggressively marketed by hospitals eager to bring in patients and the ads arent offering these details.
What Goes Wrong?
The disconcerting finding that minimally invasive radical prostatectomies have higher rates of genitourinary complications, including infection, incontinence and erectile dysfunction, was published in Journal of the American Medical Association. Comparing the minimally invasive procedure with open prostatectomy , researchers at Brigham and Womens Hospital drew data from tumor registries and Medicare, evaluating surgical outcomes of 8,837 men with prostate cancer. Of these patients, 1,938 had minimally invasive prostatectomy and 6,899 had their prostates removed the traditional way. The researchers found that the minimally invasive prostatectomies resulted in
- Shorter hospital stays
- Fewer patients requiring blood transfusion
- Fewer postoperative respiratory complications
However, these men also had
- A higher rate of infection
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 excess prostate tissue that is blocking urine flow.
- Transurethral microwave therapy : A specialized urinary catheter with a small microwave antenna is used to heat and destroy prostate tissue.
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Surgery To Remove Your Prostate Gland
You might have surgery to remove your prostate gland if:
- your cancer hasn’t spread outside the prostate gland
- you are younger and have a fast growing tumour
- as part of treatment for locally advanced or high risk localised prostate cancer
The aim of a radical prostatectomy operation is to cure prostate cancer. It is major surgery with some possible side effects. If you’re an older man with a slow growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer might grow so slowly that you’re more likely to die of old age or other causes than from prostate cancer.
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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Side Effects Of Conventional Prostate Bph Treatments And Enlarged Prostate Surgery
If you are very lucky you may well have an improved urinary function and few side effects after enlarged prostate surgery. Unfortunately, that is not the case overall.
If you think that BPH operations are harmless, think again. In my experience, side effects are not fully explained and are minimized. Why? Because doctors:
- think they are providing the best treatment based on what they know and what they have available to offer,
- often directly benefit financially from the procedures, and
- are unaware of any other options.
If they do know of alternative options, they could risk losing their medical license by offering those alternative treatments.
All of the conventional treatment options I mention on this page have consequences of:
- major discomfort to pain
- possible incontinence
- impotence and sexual difficulties
- retrograde ejaculation
- and often the treatment will need to be repeated at a future date with scarring occurring with each attempt, which makes each procedure less successful and exacerbates the side effects.
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How Is A Radical Prostatectomy Performed
The prostate is inside the pelvis and is surrounded by many other organs, including the rectum, the bladder, and the sphincter. Many important nerves and blood vessels also surround the prostate.
There are several methods for performing a radical prostatectomy. The one you undergo will depend on the location of your tumor or tumors, the extent of your cancer, and your general health and life stage.
All of these surgeries are done in the hospital and require anesthesia to prevent you from feeling pain. General anesthesia is usually used, so youll be asleep during the surgery. Epidural or spinal anesthesia can also be used. With this type of anesthesia, you cant feel anything below your waist. Sometimes, both types of anesthesia are used to control potential bleeding and to provide the best pain management.
The three main types of radical prostatectomy surgery are:
What Are The Advantages Of Cleveland Clinic’s Prostate Surgery Program
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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Electroporation Of Lymph Nodes In Prostate Cancer
Targeted and gentle removal of affected lymph nodes without irradiation or surgery
Illustration 1: The lymphatic system.1
Prostate cancer often spreads into the surrounding lymph nodes. This is called lymph node metastases. The standard treatment is the surgical removal of all pelvic lymph nodes, which is a substantial intervention. Targeted radiation therapies can be an alternative, but these therapies severely restrict the options of follow-up treatments, which are unfortunately often necessary in case of scattered cancer. With NanoKnife, there now is the possibility for high-precision and minimally invasive treatment of lymph node metastases without radiation or surgery.
What are lymph nodes and lymph node metastases?
Lymph nodes are up to one centimeter large, bean-shaped organs, which are interlinked and connected to the so-called lymphatic system. They are also part of the immune system. In the lymph system, instead of blood, lymph fluid is transported. In this system the lymph nodes are the stations, where the lymph is filtered.
Lymph node metastases are the scattered cancer cells in lymph nodes . They usually cause no symptoms. Usually they are detected either by modern imaging techniques or by the histological analysis of the lymph nodes themselves, when removed prophylactically during a surgery.
Illustration 2: The remodulation of lymphatic vessels, which pre-drives the metastasis in cancer.2
The first important step: the precise diagnosis
Uk Guidelines For Keyhole Surgery
The National Institute for Health and Care Excellence has guidelines for keyhole surgery. These state that surgeons can use it to remove cancer of the prostate but they must:
- tell people having the surgery about the risks and benefits
- monitor people closely
- collect information about any problems people have and report on them
Researchers are looking into whether keyhole surgery is as good as open surgery.
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Do I Need New Clothes After A Urostomy
Loose-fitting clothes may be more comfortable at first, but you should be able to switch back to many of your regular clothes in time. Ostomy wraps or bands can help reduce any bulge and keep it in place. You may need to give up belts that press on the stoma or clothes that are tight over it, though.