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What Is Prostate Surgery Procedure

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What Are The Risks Of Prostate Surgery

Robot-Assisted Radical Prostatectomy (RARP): What to Expect for Your Surgery?

As with any surgery, there are risks and possible side effects. These can be:

  • Reaction to anesthesia .
  • Bleeding, which may or may not require blood transfusions.
  • Blood in the urine.
  • Injury to the surrounding organs.
  • Being unable to have or maintain an erection.
  • Changes in your ability to father a child.
  • Inability to hold your urine and/or stool.
  • Inguinal hernia .

Other Things To Consider

Before you have one of these procedures, talk with your doctor about whether youâll be given something to numb the area or whether youâll be given something so you wonât be awake during the procedure. What you get and where you have it depends on the procedure.

Your doctor will give you instructions on how to prepare for any of them.

Surgery can ease many BPH symptoms, but it may not relieve them all. If there are certain complications, such as a weak bladder, there may still be urinary problems after surgery, although this is rare.

The best treatment for an enlarged prostate is not the same for every man. Talk to your doctor about the risks and benefits of each procedure.

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No Risk Of Abdominal Complications

In a robotic prostatectomy, the prostate area is accessed through the abdominal cavity. During an open prostatectomy, the surgical path is entirely outside the abdomen, eliminating the potential for injury to the abdominal contents. Any surgical complications would be confined entirely to the pelvis.

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Less Time Under Anesthesia With Open Prostatectomy

An open prostatectomy, however, is a much shorter surgery than the robotic procedure, which means patients spend less time under anesthesia. Length of anesthesia for an open prostatectomy is 2 to 3 hours, compared to 4 to 7 hours for a robotic prostatectomy.

In several measures, there is no demonstrated difference between open and robotic prostatectomy. The risk of blood transfusion for an open prostatectomy is less than 1 percent, and fewer than 1 percent of patients have wound complications. Post-operative pain on the morning following surgery is typically 2 on a 10-point scale. The patients length of stay in the hospital is 1½ to 2 days. Approximately 85 percent of patients regain excellent urinary control, and three-quarters retain sexual potency.

While all precautions are taken to reduce the likelihood of complications, no surgical treatment is completely without risk. Potential complications of open and robotic prostatectomies include infection, bleeding requiring blood transfusion, urinary incontinence, erectile dysfunction and injury to adjacent organs.

How Is Prostate Surgery Performed

Prostate surgery

Surgeons perform prostate resections to remove only part of the prostate gland when it is enlarged. These are minimally invasive procedures with no incisions in your skin. They are often done with local anesthetic or regional anesthesia, although you may require general anesthesia. If you have a local anesthetic or regional block, you will also receive a sedative to relax you during the procedure.

Here are the different prostate resection procedures:

Surgeons perform prostate removal surgeries while you are under general anesthesia in a hospital operating room. There are several approaches your surgeon may choose from, depending on your diagnosis and overall health:

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Life After Prostate Removal

For many men with prostate cancer, prostate removal is never needed because the cancer is often slow-growing and managed with non-surgical treatments. But, if the cancer has grown beyond the prostate, the oncologist may recommend prostate removal surgery, also called a prostatectomy. If you are going to have prostate removal surgery, this information can help you in your discussion with the doctors.

Is Surgery For Me

With the guidance of your physician, only you can make the final decision on whether to go through with surgery. You must weigh the risks versus the rewards and try to envision your life after surgery. Look past the short-term pain associated with the procedure and try to imagine the impact on your lifestyle. Once you review the pros and cons with your physician and understand the procedure to the best of your ability, only then can you make the decision right for you.

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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.

What Are The Risks

Robotic surgery for prostate cancer

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

Some men also 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 .

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What Is Recovery Like

Recovery from a prostatectomy may include a stay in the hospital for several days. Your entire recovery can take up to 4 weeks. You will have a temporary urinary catheter to drain urine from your bladder. You may also have drains in the belly to remove any extra fluid buildup. You will be given instructions on how to care for any catheters and drains before leaving the hospital.

Your medical team will teach you about the medications you will be taking, such as those to prevent pain, blood clots, infection, and constipation or other conditions.

Your provider will talk to you about any activities you should avoid, depending on the surgery you have had. Often these include:

  • Take prescribed medications as instructed.
  • No heavy lifting for 6 weeks after surgery. Your provider will tell you when you can go back to normal activities.
  • Walk often to prevent blood clots, pneumonia, constipation and to help maintain muscle strength.
  • Do not drive until the catheter is removed and/or while taking narcotic pain medications.
  • Avoid straining to have a bowel movement.
  • Shower as instructed. Do not tub bathe until your provider tells you that you can.
  • Avoid sexual activity until advised by your healthcare team.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Transurethral Resection Of The Prostate

In most cases, doctors use this procedure to help people with something called benign prostatic hyperplasia , an enlargement of the prostate that isn’t cancer.

People with prostate cancer have TURP done to ease symptoms like trouble peeing. Doctors don’t use this surgery to try to cure the cancer.

A surgeon removes the inner portion of your prostate gland that surrounds something called the urethra. That’s the tube where the urine leaves your bladder. Then they’ll pass a tool called a resectoscope past the tip of your into the urethra. From there, they’ll either send electricity through a wire to heat the area up or use a laser to vaporize or cut tissue.

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What To Expect After Surgery

Following surgery, most men spend one to two days in the hospital. Patients typically receive intravenous pain medication during their first day after surgery , then transition to oral pain medications by the second day. Once pain is under control and bowel function has begun to return, the patient is ready for discharge.

Questions To Ask Before Surgery

Newly Diagnosed

As you think over the options for surgery, ask your doctor these questions:

  • Is there a good chance my condition will get better?
  • How much will it improve?
  • What are the chances of side effects from a treatment?
  • How long will the effects last?
  • Will I need to have this treatment repeated?

With newer technologies, doctors can do some minimally invasive procedures with tiny cuts or use tube-style instruments that they insert into you. These procedures may not treat the symptoms to the same degree or durability as more invasive surgical options, they do have faster recoveries, less pain afterward and have reduced risks.

Other times, the traditional and more invasive surgery may be needed. It all depends on your case and what you and your doctor decide is best for you.

Doctors can choose from these minimally invasive procedures, endoscopic, or open surgeries to treat moderate to severe symptoms. These procedures are also used if tests show that your ability to pee is seriously affected.

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What Happens After Robotic Prostate Surgery

  • Robotic prostate surgery operative time is typically 2-4 hours
  • Hospital stay is typically 1-2 days
  • Our team will be seeing you on a daily basis during your stay in the hospital and will give you detailed after-surgery instructions prior to your discharge home.
  • Foley Catheter typically comes out on day 5 after a cystogram
  • Jackson Pratt drain comes out around the time of Foley catheter removal depending on your individual circumstances
  • No driving for 7 days after prostate surgery
  • No other restrictions in physically activities after surgery – just do what you can tolerate
  • Aspirin can be restarted when you are back to eating regular meals
  • The first PSA check after prostate surgery is at 1 month and then 3-6 months thereafter.

Advantages Of Ralp Over Traditional Surgery Include:

  • Small incisions
  • Less blood loss than in traditional surgeries
  • Less pain than an open incision surgery
  • Less risk of infection over other kinds of surgery
  • Shorter stay in the hospital
  • Faster recovery at home

The magnification system provides your surgeon with a clear view of the tiny blood vessels, nerves, and muscles surrounding your prostate to help minimize side effects after your surgery.

Not every man who needs prostate removal surgery will be a candidate for robotic surgery. Each prostate cancer patients situation is unique, with some patients requiring a different surgical method either traditional open surgery or, less frequently, radical perineal prostatectomy.

If you have recently been diagnosed with prostate cancer and are looking for a second opinion on treatment options before undergoing surgery, consult with one of the prostate cancer specialists at Compass Oncology located throughout the Portland-Vancouver area.

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Why The Procedure Is Performed

An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your doctor may tell you changes you can make in how you eat or drink. You may also try some medicines.

Your doctor may recommend prostate removal if you:

  • Cannot completely empty your bladder
  • Have repeat urinary tract infections
  • Have bleeding from your prostate
  • Have bladder stones with your enlarged prostate
  • Urinate very slowly
  • Took medicines and they did not help your symptoms

What Are Laparoscopic And Robotic Surgery

HoLEP Procedure – Mayo Clinic Health System

Laparoscopic and robotic prostate surgery are minimally invasive techniques for performing surgery. Both these procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally invasive surgery with advanced robotic technology.

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Surgery May Be Required To Treat A Range Of Conditions That Affect The Prostate Here We Take A Look At The Three Most Common Types Of Prostate Surgery

Prostate surgery is a very effective treatment for a number of conditions, the two most common being prostate cancer and benign prostatic hypertrophy .

In the case of cancer, these procedures are performed to stop the spread of malignant cells. For BPH, surgery may be required to relieve symptoms that are making it difficult to urinate, which can have a significant impact on quality of life.

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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Maximum Treatment Minimum Side Effects

California Protons, located in San Diego, is the only center in the state using clinically proven, revolutionary technology to deliver proton therapy radiation with unmatched precision and the utmost care. Its one of the safest and most effective prostate cancer treatments in the world, which can result in high cure rates, reduced side effects and improved outcomes.

Advantages And Disadvantages Of Surgery

Prostate Cancer and Benign Prostatic Enlargement

What may be important for one person might be less important for someone else. The advantages and disadvantages of surgery may depend on your age, general health and the stage of your cancer.

Advantages

  • If the cancer is completely contained inside the prostate, surgery will remove all of the cancer.
  • The prostate is looked at under a microscope to give a clearer picture of how aggressive your cancer is, whether it has spread outside your prostate and if you need further treatment.
  • Your health professionals can get a good idea of whether your cancer was completely removed during surgery. Your PSA level should drop so low that its not possible to detect it at six to eight weeks after surgery.
  • If there are signs that your cancer has come back or wasnt all removed, you may be able to have further treatment.
  • Some men find it reassuring to know that their prostate has been physically removed, although you will still need to have follow-up tests to make sure no cancer cells have spread outside the prostate.

Disadvantages

  • There are risks in having surgery, as with any major operation.
  • You might get side effects such as erection problems and urinary problems.
  • Youll need to stay in hospital for a few days usually between one and five days depending on the type of surgery you have.
  • If the cancer has started to spread outside the prostate, the surgeon may not be able to remove all of the cancer and you might need further treatment.

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What Are The Types Of Prostate Surgery For Benign Prostatic Hyperplasia

Several minimally invasive surgeries may be used for benign prostatic hyperplasia. These include:

GreenLight laser: Photoselective vaporization of the prostate is a treatment that vaporizes prostate tissue to create a channel in the urethra for free urination. This is surgical treatment performed in the operating room under general anesthesia.

Plasma button electrovaporization: Prostate tissue is removed using low temperature plasma energy. Tissue is vaporized. This is an operating room-based therapy and requires an anesthetic.

Water vapor therapy : Water vapor is directly delivered to the prostate tissue. Over a 3-month period the tissue is destroyed and reabsorbed by the body. This is an office-based therapy and is performed under a local nerve block.

UroLift®: A mechanical approach that places implants to pin the lateral prostate lobes out of the way to reduce obstruction. This is an office-based procedure performed under a local nerve block.

Prostatic artery embolization: This approach uses catheters to deliver agents that block blood flow to the prostatic artery to reduce symptoms of BPH by shrinking tissue. This prostate procedure uses local anesthesia and doesnt require a hospital stay.

What Is The Most Common Approach

A technique called transurethral resection of the prostate is considered to be the standard surgical approach. This procedure involves inserting a thin tube called a resectoscope into the urethra and guiding it through to the prostate. The resectoscope is equipped with a tiny camera and an electrical loop that is used to mechanically remove prostate tissue. The loop produces heat at the same time, which quickly seals off the blood vessels. The resectoscope also has valves that regulate the release of fluid to flush the removed tissue out. TURP takes about 90 minutes and is done under local or general anesthetic. Men who have had this procedure usually need to have a urinary for a few days after, and generally stay in the hospital for two to seven days. They then have to rest and take it easy for a few weeks.

Some variations of TURP are also considered to be standard treatments and have similar outcomes and consequences to conventional TURP. These include transurethral electrovaporization , transurethral vaporesection and plasmakinetic enucleation of the prostate .

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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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