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 Does The Robotic
It is similar to the conventional, minimally invasive laparoscopic prostatectomy. However, working from a special console in the operating room, the surgeon operates four precision-guided robotic arms to cut and remove the prostate. The procedure uses a small video camera, inserted through a keyhole-sized incision to provide surgeons with magnified, 3-D images of the prostate site. This expansive view allows doctors to see the nerve bundles and muscles surrounding the prostate. The robotic arms, with full 360-degree rotation capabilities, are placed through several other keyhole incisions allowing surgical instruments to move with greater precision, flexibility and range of motion than in a standard laparoscopy.
The procedure usually takes 2 to 3 hours under general anesthesia. Most patients experience only a small blood loss and blood transfusions are needed in less than one percent of patients. Prostatectomy patients typically spend one night in the hospital and are usually discharged as soon as their laboratory tests are acceptable, pain is controlled and they are able to retain liquids. Patients are discharged with special catheter, which is removed during an outpatient visit 5-7 days after the operation.
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.
Are There Side Effects From Having A Urinary Catheter
Yes, there can be side effects or unwanted changes in your body when you use a urinary catheter. Side effects are different from person to person. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. There are several side effects that you may have if you have a urinary catheter. They are bladder spasms, blood in your urine, and infections.
Urinary tract infections. Infections of the urinary tract are very common. An infection is when germs enter your body causing you to have a fever or pain, redness, and swelling in one part of your body. To lower your risk of getting an infection:
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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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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.
Robotic Prostate Surgery Details
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 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 surgeons sophisticated maneuvers.
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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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Cost Of Enlarged Prostate Treatment Without Insurance
At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.
At New York Urology Specialists, we offer a flat-fee all-cost-includedRezum procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment. Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.
At New York Urology Specialists, we offer a flat-fee all-cost-includedUrolift procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.
Points To Take Into Consideration After A Prostate Surgery
- 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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Patient Positioning And Compartment Syndrome
Proper patient positioning has a critical role in any surgical procedure. It is necessary for adequate exposure and access, and also reduces the iatrogenic injuries as compartment syndrome and peripheral nerve damage.
Intraoperative physiologic changes include increased intraocular pressure, central venous pressure, intracranial and pulmonary venous pressure, and decreased functional residual capacity and pulmonary compliance. Lung functions may be compromised prominently if the patient is too tightly taped to the table. Prolonged Trendelenburg position may result in pooling of the venous blood in upper extremities. Subsequently, head and neck edema may be seen and also re-intubation may be required due to laryngeal edema and posterior ischemic optic neuropathy even after minimally invasive radical prostatectomy. Orbital stretching or direct compression from facedown prone positioning may also cause permanent vision loss.
The absolute mechanism of PION is unknown, but might be the result of optic nerve ischemia. Multiple factors have been proposed as underlying mechanisms of PION but the PION cases after open radical prostatectomy is found to be associated with prolonged hypotension as the result of excessive blood loss. Urologists should immediately consult such patients to ophthalmologists.
Anatomical Structure To Prevent Postoperative Incontinence In Men: Lessons Learned From Women
SUI is certainly a public health problem, affecting QOL mainly in females. Understanding the anatomical and functional structure in the female pelvis, and the pathophysiology of female SUI, has contributed to insight in generating the procedures to improve this condition. Therefore, this knowledge contributes to the development of intraoperative techniques to improve the early return of urinary continence after RARP. In general, the anatomical structure to maintain continence includes two systems: a sphincteric system and a supportive system, in both males and females., As a result of RP, these two systems are impaired, and consequently induce postoperative urinary incontinence.
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Where Can I Find Prostate Cancer Support Groups
Even though once you complete the surgery you most likely will find yourself cancer-free, the anxiety and stress may never totally go away. The support of your friends and family is essential in these moments, but the most relief you will find is among people that have gone through the same experience.
We advise you to search locally for prostate cancer or cancer survivors support groups and discuss your journey in beating this. You will find there plenty of people that lived through the same emotions and painful experiences and you will gather your strength to overcome this and not let it define the rest of your life.
If physical presence is not an option for you, there are plenty of forums and online communities that gather around this subject. You can find people that share their experiences and advice below:
Prostate cancer surgery is not as severe of a surgery as other ones. The recovery, especially after robotic surgery, usually lasts up to 2 to 3 weeks and patients can return to work and to living their normal lives.
How Is Postoperative Bleeding Treated
- A blood transfusion may be done to give you donated blood through an IV.
- Blood components may be given during a transfusion to help stop your bleeding. Blood components are the parts of blood that help it to clot. Examples are clotting factors, platelets, and plasma.
- Antifibrinolytic medicines may slow or stop your bleeding.
- Surgery may be done to fix the blood vessel or area that is bleeding.
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Surgery For Prostate Cancer : Introduction
Radical prostatectomy has been performed as an open surgery for quite some time with good success, however as minimally invasive surgery has evolved, it has become possible to perform radical prostatectomies laparoscopically. Recent leaps in technology with the advent of Intuitive Surgical Inc.s da Vinci robot have taken radical prostatectomy past laparoscopy to an all new level of success. In the hands of a skilled surgeon like Dr. Ahlering, of UC Irvine Medical in Orange County, this new tool allows the radical prostatectomy to be performed minimally invasively with greater precision and ease to both the patient and the surgeon than ever before.
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 About Problems With Urinary Continence
Urinary continence depends on the internal, involuntary sphincter and the voluntary striated external sphincter. The internal sphincter is removed during all forms of prostatectomy, as it is anatomically at the junction of the prostate and bladder. Performing specialized Kegel exercises after surgery to strengthen muscles enables patients to control their external sphincter and gain continence . This takes several weeks to several months. Overall, significant urinary leakage occurs in only 0.5 percent of UC Davis patients. About 15 percent of patients report mild stress incontinence.
Will Kegel Exercises Help With My Urinary Control
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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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.
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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:
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Another type of prostate issue is chronic prostatitis, or chronic pelvic pain syndrome. This condition causes pain in the lower back and groin area, and may cause urinary retention. Symptoms include leaking and discomfort. In severe cases, a catheter may be required to relieve the symptoms. If the problem is unresponsive to other treatments, your doctor may suggest a surgical procedure. If these do not work, your symptoms could progress and become chronic.
An acute bacterial infection can cause a burning sensation. Inflammation of the prostate can affect the bladder and result in discomfort and other symptoms. This is the most common urinary tract problem in men under 50, and the third most common in men over 65. The symptoms of acute bacterial prostatitis are similar to those of CPPS. Patients may experience a fever or chills as a result of the infection.
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 patientâs health status. However, overall recovery time is short.
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