Wednesday, November 30, 2022

Where Is The Incision For Prostate Removal

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Your Cancer Care Team

Robotic Assisted Laparoscopic Radical Prostatectomy | Brigham and Women’s Hospital

People with cancer should be cared for by a multidisciplinary team . This is a team of specialists who work together to provide the best care and treatment.

The team often consists of specialist cancer surgeons, oncologists , radiologists, pathologists, radiographers and specialist nurses.

Other members may include physiotherapists, dietitians and occupational therapists. You may also have access to clinical psychology support.

When deciding what treatment is best for you, your doctors will consider:

  • the type and size of the cancer
  • what grade it is

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Why It Is Done

A radical prostatectomy is done to remove prostate cancer. It is most often used if testing shows that the cancer has not spread outside the prostate.

It is sometimes used to relieve urinary obstruction in people with advanced cancer. But a different surgery, called a transurethral resection of the prostate , is most often used for that purpose. Surgery usually is not considered a cure for advanced cancer. But it can help relieve symptoms.

The Steps Of The Robotic Surgery:

Robotic surgery is really a remote control operation, where the surgeon sits at a real distance from the patient and as he does the surgery, the entire movements of the surgeon are translated through the sensitive fibers of the machine with certain precision to the tip of the instruments.

  • Keyhole incisions are being made in the patients abdomen
  • Fine robotic instruments are being placed inside the abdomen
  • A 3D endoscope and an imaging device is being placed inside the abdomen for enhanced precision
  • The surgeon operates the console to maneuver the instruments so as to cut and remove the prostate
  • The prostate is being removed through one of the keyholes
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    Radical Prostatectomy Perineal Approach

  • You’ll be placed in a supine position in which the hips and knees will be fully bent with the legs spread apart and elevated with the feet resting on straps. Stirrups will be placed under your legs for support.

  • An upside-down, U-shaped incision will be made in the perineal area .

  • The doctor will try to minimize any trauma to the nerve bundles in the prostate area.

  • The prostate gland and any abnormal-looking tissue in the surrounding area will be removed.

  • The seminal vesicles may be removed if there’s concern about abnormal tissue in the vesicles.

  • Success Of Radical Prostatectomy

    Radical perineal prostatectomy

    The goal of radical prostatectomy is to cure prostate cancer. But a prostate cancer cure is only possible from prostatectomy if your prostate cancer is limited to the prostate.

    During radical prostatectomy, a member of your treatment team examines your removed prostate under a microscope to see if your cancer has reached the edge of the prostate. If so, the prostate cancer has probably spread. In these cases, you may need more treatments.

    Men with no evidence of prostate cancer spread have an 85% chance of surviving 10 years after radical prostatectomy.

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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

    Leading Specialists In Laser Ablation Procedure For Prostate Tumors

    Are you, or is someone you love, at risk for prostate cancer? Have you been told that your PSA test results are high and you need a biopsy? Have you had a positive biopsy? Are you exploring alternatives to surgery or radiation?

    The world of prostate cancer can be overwhelming, with confusing and conflicting information about the disease and its treatments, but little explaining what is happening inside your own body.

    Rest assured. The Sperling Prostate Center team is here to put your mind at ease.

    Patient Greyson Quarles tells his story

    The Sperling Prostate Center in Florida offers noninvasive advanced imaging as a revolutionary first step in prostate tumor detection and diagnosis. The more you know about what is happening in your body, the more informed and rational your healthcare decisions will be. The best education is having a clear picture of what is going on within your own body. Dr. Sperling and his team will welcome and support you as advanced images are captured, your prostate gland is mapped, and the results are explained to you in a way you can fully understand.

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    What Is Prostate Cancer Ablation

    To begin, its important to understand what ablation is. Ablation means the removal of diseased body tissue such as cancerous tumors. Image-guided ablation is performed by applying thermal energy that physically destroys the cancer. For prostate cancer, ablation is an alternative to surgery or radiation.

    Thermal ablation for prostate cancer has two main advantages over surgery:

    • Same day outpatient procedure
    • Very rapid recovery time and return to normal activities

    Ablation also has a unique advantage over surgery and radiation, which are both whole-gland treatments. Ablation can be done as a focal treatment with added benefits:

    • Targets only the tumor plus an extra safety margin
    • Avoids damage to healthy prostate tissue
    • Greatly reduces the risk of impaired urinary and sexual function as compared to surgery

    Today, focal treatment for prostate cancer is recognized as an excellent option for patients who are accurately diagnosed and determined to be appropriate for a focal approach. Besides being clinically qualified, psychologically they desire high quality of life after treatment and are committed to actively participating in their doctors follow-up monitoring protocol using PSA blood tests and multi-parametric MRI scans at prescribed intervals.

    Advantages And Disadvantages Of Surgery

    Radical Prostatectomy (Prostate Cancer Surgery)

    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

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    How Will Prostate Surgery Affect My Sex Life

    Experienced robotic surgeons like Dr. David Samadi dont open the endopelvic fascia during surgery, which spares the rick of damage to nerve bundles that control sexual function. The recovery of the function, however, is not immediate and you should not feel discouraged if weeks or even a few months after surgery you experience erectile dysfunction. It is not an indication of long-term damage.

    Radical Prostatectomy Retropubic Or Suprapubic Approach

  • You’ll be positioned on the operating table, lying on your back.

  • An incision will be made from below the navel to the pubic region.

  • The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.

  • The prostate gland will be removed.

  • A drain will be inserted, usually in the right lower area of the incision.

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    What Are The Types Of Radical Prostatectomy

    Your surgeon will choose among several types of radical prostatectomy:

    • Open radical prostatectomy: During this traditional type of surgery, your surgeon makes a vertical incision between your belly button and pubic bone. Your surgeon inserts tools through the incision to remove the prostate and surrounding tissue.
    • Robot radical prostatectomy: Your surgeon makes several small incisions or one single incision across your abdomen. During the surgery, your surgeon operates state-of-the-art robotic controls outside your body. They can see the surgical area with a magnified view on a 3D screen.

    More Treatment Stories In Our Patients Own Words

    Prostate Cancer and Benign Prostatic Enlargement

    Dr. David: A Whole New Chapter of Good Health

    My journey began in September of 2020 with an elevated PSA and as any man can attest its a silent fear we all hope not to encounter. After researching the many options of treatments, I found your website that gave me hope of the best treatment possible. From my very first telephone call to the follow up MRI in September 2021, I could never have asked for a more thorough, professional, articulate, personal and pleasant experience. You provided explicit and detailed explanations of all my assessments, test results and recommended procedures while providing the most valuable tool of all you listened to my questions and concerns. Your responses put me at ease that I had made the right choice in finding you for treatment of my prostate cancer.

    My hope is that you truly sense that my two small words of saying thank you do not even begin to hold their meaning. My health is excellent, the fearful diagnosis of prostate cancer is behind me with you providing the best treatment any man could possibly hope for and as I continue to follow your regime of follow up exams, I feel its a whole new chapter of good health to enjoy!

    Steves Story

    Kevin: An Informed Decision

    Warren: A Life-Changing Experience

    Hermans story

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    Life After Prostate Removal: What To Expect

    The prostate gland is prone to inflammation and developing cancer.

    Almost half of the men above the age of 60 have benign prostate hyperplasia or prostate enlargement.

    However, BPH does not cause removing the prostate, but the presence of cancer or its early sign is the reason for prostate removal.

    Prostate cancer has become a significant concern in recent years. Its incidence is increasing, and now its diagnosis is becoming more common even among middle-aged men.

    Prostate cancer is now among the most common cancers in older men.

    Aging indeed has lots to do with the increased prostate cancer rate, but it is not the only cause. It seems that this disproportionate increase in the annual incidence of prostate cancer also has to do with other lifestyle issues like a high-fat diet, greater prevalence of metabolic disorders, environmental toxins, hormonal changes, and more.

    The prostate plays an important role in male fertility and sex life. Although men can survive without a prostate, unfortunately, for many men, prostate removal results in poor quality of life, issues like erectile dysfunction, and more.

    Some men can expect to recover well from proctectomy. However, for others the journey to recovery is prolonged and distressing. Keep reading to find out more about life after prostate removal and what you can expect.

    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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    Where Does Prostate Cancer Spread

    The most common place for prostate cancer to spread to is the bones. It can also spread to the lymph nodes, liver and lungs and other organs.

    A large tumour in the prostate gland can spread into or press on areas around the prostate, such as the back passage or urethra. The urethra is the tube which carries urine from the bladder to the outside of the body.

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    How Can A Prostatectomy Impact Your Quality Of Life

    Transurethral Resection of the Prostate (TURP)

    Prostatectomy is not life-threatening, but prostate removal significantly affects the quality of life, and it may cause problems like urinary symptoms, bladder issues, erectile dysfunction, and more. T

    These issues may last for several months and even years, something patients should be ready for if they decide to have the surgery.

    However, a lot depends on the patients age and the kind of surgery done. Studies show that about 60% of patients would make an almost complete recovery within 3 months with no long-term complications. By 12-months, almost 90% of patients can expect to feel much better and nearly normal.

    Unfortunately, improvement is slow for some people, and they need 2-3 years to revive their sexual function and get rid of urinary issues. Regretfully, these issues may continue to haunt some for a while.

    Here it is vital to understand that the above data is for radical proctectomy . The outlook is better after partial proctectomy.

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    What Is Classical Open Surgery

    Open surgery, also known as open radical prostatectomy, is the classical surgical approach in which the surgeon accesses the prostate by means of incision.

    In this operation, the aim is to extract the whole prostate gland and some of the adjacent tissue. In some situations, the lymphatic glands in the pelvic area are also removed.

    Classical surgery involves longer recovery time, but the procedure itself is usually quicker in comparison with laparoscopic prostate surgery.This significant urological operation is important and difficult to perform given its potential aggressivity, delicacy and the dexterity required to perform it correctly.

    Surgery is indicated for patients with clinically localised tumours and, in some cases, locally advanced tumours .

    Contraindications To Open Prostatectomy

    Open prostatectomy is contraindicated in the presence of prostate cancer. If cancer is suspected, a formal prostate biopsy should be performed before surgery is considered.

    If cystoscopy findings indicate that the obstructing adenoma primarily involves the median lobe, the suprapubic approach may be preferred to the retropubic technique, because the suprapubic procedure optimizes anatomic exposure.

    In addition, retropubic prostatectomy offers only limited access to the bladder, which is an important consideration if a bladder diverticulum requiring excision coexists or if a large bladder calculus must be directly removed.

    The perineal approach can be contraindicated in patients in whom sexual potency remains important. In this procedure, the perineal neurovascular anatomy is invaded more extensively than it is in the other available open techniques.

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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.

    Transurethral Resection Of The Prostate

    Prostate surgery

    Transurethral resection of the prostate is a urological operation that involves cutting away a section of the prostate. It is most often used to relieve symptoms of urinary blockage, not necessarily to treat prostate cancer.

    An instrument called a resectoscope is inserted through the opening of the urethra and the surgeon removes the inner part of the prostate gland .

    The intervention lasts about an hour and it is most often used for non-cancerous blockage, but may also be used in cases of prostate cancer. The doctor doesnt need to make any incisions on the body. While most people can go home the same day, it is also likely that patients spend one or two days in the hospital. After the surgery, a urinary catheter will be placed because of the swelling that blocks urine flow.

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