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What Happens Before Radical Prostatectomy

‘To Leak or not To Leak’ after Prostate surgery – by Kim Toyer

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:

How Can I Improve Incontinence After Prostate Surgery

Want to stop incontinence after prostate surgery? Kegels may be your answer! As mentioned above, Kegels are a common treatment option for incontinence after prostate surgery. Among other things, the pelvic floor muscles help control bladder and bowel function and, like other muscles of the body, if they get weak they are no longer able to do their job effectively. To improve muscle function, Kegels must be done regularly, every day. The good news is that they can be performed pretty much anywhere, anytime, and in a variety of positions . For a complete guide on performing a mens kegel, click here.)

Biofeedback can sometimes be used to determine if you are performing a kegel properly. And, electrical stimulation may also be used to help re-teach the muscles to contract.

Pain Is A Common Side Effect

Even the healthiest of men tend to find that their penile region is highly sensitive. Consequently, having a major surgical procedure in that region of the body often means that men experience significant amounts of pain as a result of prostate surgery.

Since the surgery must be performed near the rectum as well, pain can occur for some men when using the bathroom. In many cases, the pain subsides with time. For some men, however, the pain can be long-lasting or recur occasionally, especially if it is associated with the lymphatic system.

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When Should I See My Healthcare Provider

Talk to your healthcare provider if you have any of these symptoms after your surgery:

  • Bleeding, swelling or drainage from the incisions.
  • Inability to have a bowel movement.
  • Inability to urinate after catheter removal.
  • Increased pain around the incisions.

A note from Cleveland Clinic

Radical prostatectomy is a common surgery to remove the entire prostate gland. This prostate cancer surgery may be robotic surgery or open surgery. Robotic surgery has a shorter recovery time. Full recovery can take weeks, with some side effects lasting for months. Light exercise and medication can help you heal faster.

Last reviewed by a Cleveland Clinic medical professional on 08/03/2021.

References

Robotic Prostate Surgery Details

Characterization a model of prostatic diseases and obstructive voiding ...

Using the advanced surgical system, miniaturized robotic instruments are passed through several small keyhole incisions in the patients abdomen to allow the surgeon to remove the prostate and nearby tissues with great precision. This is much less invasive than a conventional radical retropubic prostatectomy, which involves an abdominal incision that extends from the belly button to the pubic bone.

During robotic-assisted radical prostatectomy, a three-dimensional endoscope and image processing equipment are used to provide a magnified view of delicate structures surrounding the prostate gland , allowing optimal preservation of these vital structures. The prostate is eventually removed through one of the keyhole incisions.

For most of the surgery, the surgeon is seated at a computer console and manipulates tiny wristed instruments that offer a range of motion far greater than the human wrist. The surgery is performed without the surgeons hands entering the patients body cavity.

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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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Facts Every Man Should Know Before Prostate Cancer Surgery

Many men want to know what prostate cancer surgery is like, including what to expect before surgery and what to expect afterwards.

Here are my findings based upon more than 1,000 phone calls to men the day before surgery, almost 700 visits to men the day after surgery and hundreds of calls from men in the weeks following surgery.

  • Most men experience very little surgical pain – probably 80 percent are like me…I had my surgery on a Monday by Friday I was at a graduation party . I got by with only Advil for pain relief. It’s been described as feeling like they did too many sit-ups.
  • Men really fear the catheter. I let them know that they will be asleep when it is put in. They may be like me and sleep very well with it in. Changing bags from a large capacity night bag to a smaller capacity day bag is simple and doesn’t involve removing the catheter. Walking with the day bag catheter is not a problem. Removal of the catheter is usually done in the doctor’s office after the prescribed timeframe and is relatively pain-free.
  • If all goes as planned, you will be walking the night of surgery and then the next day. Most men go home the following afternoon, unless they are otherwise directed by the doctor.
  • Your biggest discomfort may be from gas pains, hence the walking. For a robotic surgery, they have to fill the body cavity with gas to manipulate the equipment. Until we get rid of the gas in the normal way we do, there can be discomfort.
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    While In The Hospital

    It’s important to your recovery to start moving as soon as possible. Most men are out of bed and walking around the unit on the same day as their surgery. Your nurse will assist you until you can manage on your own. When you first get up, raise the head of your bed, take a couple of deep breaths, and allow your body to adjust to the change in position. Dangle your feet over the side of the bed for a few minutes, then slowly stand up. Be careful because getting up too quickly can make you light-headed.

    Get out of bed at least three times each day preferably more. This helps prevent lung infections and blood clots. You may be prescribed an injectable blood thinner to further reduce the risk of blood clots. The more time you spend out of bed, the faster you will recover and the faster your bowel function will return to normal. Your nurse will also give you an oral stool softener and mild laxative to prevent constipation.

    In addition to walking, you will be encouraged to do two other things that help prevent complications: Use an incentive spirometer , and wear compression stockings while in bed. Both will be provided and the nurses will instruct you on how to use them.

    Risks Of Radical Prostatectomy

    Fixing Urinary Leakage After Prostate Cancer Surgery | Ask A Prostate Expert, Mark Scholz, MD

    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 Happens When My Urinary Catheter Is Taken Out

    The day your catheter is taken out is a big step forward in your recovery. Taking out your catheter will only take a couple of seconds and is not painful. You may feel a slight tug or a pulling feeling as it comes out, but it does not hurt. You will probably feel very relieved to no longer have your catheter.

    When your catheter is removed, you will probably leak or pass urine when you dont want to. This is called incontinence. Remember to bring an incontinence pad, like Depends, with you to the doctors office or clinic. Being unable to control your urine after your catheter is taken out is normal. This should get better over time. There are also exercises, called Kegel Exercises, which you can do to make the muscles that control your urine flow stronger. For more information, please see the IMPACT booklet, Kegel Exercises for Men. Your doctor or health care team can also give your information on how to do these exercises.

    Before Surgery Start Your Pelvic Floor Exercises

    • These should be started before surgery and only stopped once you are completely continent after the operation.
    • Youll be shown how to do the exercises during your pre-operative assessment visit, but essentially these pelvic floor muscles are the ones that you use to interrupt your urine stream. A strong pelvic floor therefore allows you greater control over your continence after the operation.
    • More precisely, the muscles aid urinary control whilst your valve of continence recovers from the operation. This valve essentially switches your urine stream on and off, and is affected during surgery. Stitches in the valve take 6 weeks to dissolve and the scar tissue surrounding it takes up to a year to soften, so we need to help it after the operation. By creating a strong pelvic floor with your exercises, the muscles are able to squeeze around this valve and help it to close during the recovery period.

    Ill be covering how to perform the exercises in a later article as its slightly out of the scope of this article, but for now there is an excellent guide from Prostate Cancer UK here, as well as a video to watch here.

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    How Is Postoperative Bleeding Diagnosed

    Your healthcare provider will look for the source of your bleeding. He will ask about your health, and if you or anyone in your family has a bleeding disorder. He will ask what medicines you take, including over-the-counter medicines, and vitamin or herbal supplements. You may also need any of the following:

    • Blood tests may be done to show how well your blood clots.
    • Procedures such as endoscopy and angiography may be used to find the source of your bleeding, or to control it. An endoscope is a long, bendable tube with a light on the end of it. An angiogram is a picture of your arteries. You may be given a dye to help the blood vessels show up better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.
    • Surgery may be done in the same area to pinpoint where the blood is coming from.

    Points To Take Into Consideration After A Prostate Surgery

    Pelvic Health Kapiti Coast, Physio Paraparaumu
    • Do not sit on hard floors.
    • Avoid getting constipated.
    • Consume at least 3 liters of water per day.
    • Regularly use the drugs prescribed by your doctor.
    • Do not drive for the first week during the recovery period after surgery. In addition, stay away from activities such as cycling, exercising, and horseback riding for 6 months, which may strain the groin area.
    • Do not wear trousers that tighten the groin area.
    • Do not consume drinks that contain alcohol and caffeine.
    • Do not shower in a sitting position after the surgery, unless your doctor tells you otherwise.

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    What Can I Expect Before And After Robotic Prostatectomy

    If after consulting with Dr. Engel, becoming educated on the topic of prostate cancer, potentially seeking other opinions, and being presented all options, a patient opts for robotic prostatectomy, he will then be taken extensively through what to expect. Dr. Engel currently performs robotic surgery exclusively at George Washington University Hospital, and a date and time will be scheduled for surgery there. The patient will generally be urged to see his internist for a pre-operative physical, although this can also be accomplished at the hospital itself. Tests to rule out spread of cancer such as a bone scan and CT scan, looking for spread to bones and lymph nodes, may be performed in higher risk cases. The patient will be given detailed instructions regarding a bowel preparation regimen and the patient must follow this strictly. The purpose of the bowel prep is not only to create more space in the abdomen, but also for safety in the very unlikely event that there is an inadvertent injury to the intestine or rectum during the surgery. If this occurs, a bowel prep will likely keep this from being a life threatening problem.

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    What Are The Side Effects

    The most common side effects of surgery are leaking urine and problems with getting or keeping an erection .

    Your risk of getting these side effects depends on your overall health and age, how far the cancer has spread in and around the prostate and how likely it is to grow, and your surgeons skill and experience.

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    What Are The Benefits To Patients

    Robotics procedures, and minimally invasive surgeries in general, involve smaller incisions than traditional open surgeries, which reduces blood loss and postoperative recovery times. Patients typically experience significantly less pain and blood loss than in conventional open incision procedures. Patients also tend to enjoy quicker recovery times. Traditional open surgery can require several days of hospitalization and recovery time can last several months. While every case is unique, the return to normal, everyday activities following robotic-assisted surgery can occur in as little as two to three weeks.

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    Will Kegel Exercises Help With My Urinary Control

    Which is Better – Surgery vs. Radiation for Prostate Cancer?

    Kegel exercises are recommended and contribute to regaining urinary control. Dr. David Samadi even encourages patients to start them before surgery as a type of pre-conditioning. Kegels are a simple exercise of clenching and releasing the muscles that control your urine flow.

    Kegels must be done every day to strenghten the pelvic floor muscles. Check this Mayo Clinic article on how to perform these exercises.

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    Postoperative Care After Prostate Surgery

    After a healthy operation and discharge, there are some rules that you must follow. There is a risk of bleeding for the first several months after surgery. Therefore, there are some points to take into consideration. The length of the recovery period after prostate cancer surgery varies depending on some conditions. There are factors such as the type of surgery, the stage of disease, and the patient’s health status. However, overall recovery time is short.

    About Your Prostate Surgery

    A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. Some of the lymph nodes in your pelvis are removed as well. This is done to prevent cancer from spreading from your prostate to other parts of your body.

    A radical prostatectomy can be done in 1 of 2 ways. One way is through an open incision , which is called an open prostatectomy. Another way is to use a laparoscope, which is a tube-like instrument with a camera. Your surgeon will talk with you about the best surgery option for you.

    Open prostatectomy

    In an open prostatectomy, your surgeon will make an incision that goes from your pubic bone towards your belly button . Theyll remove the pelvic lymph nodes first, followed by the prostate gland, and then the structures next to it.

    Figure 2. Open prostatectomy incisions

    Laparoscopic or robotic-assisted prostatectomy

    During a laparoscopic or robotic-assisted prostatectomy, your surgeon will make several small incisions in your abdomen . Theyll insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. Surgical instruments will be inserted into the other incisions to remove the prostate. Some surgeons at MSK are specially trained to use a robotic device to help with this procedure.

    Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions

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    What Is The Recovery Time After Radical Prostatectomy

    You may feel tired for a few weeks after surgery. Light exercise such as walking can help with the healing process. You should avoid heavy lifting for several weeks.

    You may have urinary incontinence or leakage for weeks to months after the surgery, although most people recover continence after surgery. Recovery of sexual function is expected to take months. Your doctor may start you on a medication to help with recovery of erections.

    Youll need regular follow-ups with your healthcare provider to monitor for evidence of cancer recurrence and manage effects from the surgery. They can work with you to improve any problems with erectile dysfunction or bladder control.

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