Msks Approach To Radical Prostatectomy
Our prostate surgery team includes experts in several techniques, including robot-assisted surgery, open surgery, and laparoscopic surgery. Regardless of which surgical approach you choose, our goal is to remove your cancer completely and preserve normal urinary and sexual function.
With all surgical approaches, weve developed and use innovative techniques to preserve the tiny nerves and blood vessels attached to the prostate that help control erections. These and other advances have made some of the complications of prostate cancer surgery less common and more manageable and can spare nerves from damage. Well work closely with you and your medical team to manage any short- or long-term side effects you may experience.
Ultimately, youll help determine which approach your surgeon takes.
Your Cancer Care Team
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
- whether the cancer has spread to other parts of your body
Prostatectomy And Sexual Issues
As a man, your prostate gland plays several important roles in your bodys sexual and urinary function.
During sex, your prostate gland is responsible for releasing seminal fluid, or semen, into your urethra. As you reach orgasm and ejaculate, the muscle tissue of your prostate forces semen and sperm out from your penis.
The nerves that surround your prostate also play an important role in allowing blood to flow to the erectile tissue of your penis when youre sexually aroused.
Because prostate surgery involves removing the prostate gland, its normal to lose some parts of your normal sexual function after the surgery.
For example, radical prostatectomy involves cutting the connection between your urethra and your testicles. This means that sperm is no longer able to flow down your urethra and out the tip of your penis during sex.
As a result of this, men who undergo radical prostatectomy surgery can still reach orgasm, but arent able to ejaculate.
Several different approaches are used to remove your prostate gland during surgery. Some of these approaches particularly those used to treat prostate cancer may result in damage to the nerves that surround your prostate gland, testicles and penis.
Nerve damage caused by prostatectomy surgery may affect your erectile health. If your nerves need to be cut during the procedure , you may find it difficult or impossible to get and/or maintain an erection after surgery.
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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:
Things That Can Happen When You Live Without A Prostate
Beyond the oft-reported effects of urinary incontinence and impotence following surgery, there are a number of less widely known possible side effects of prostate removal.
Fun fact number one: Half of all men who die in this country this year will be killed by heart disease, stroke, or cancer. Fun fact number two: Half of all doctors seem to have different ideas about how to prevent the biggest killers of men. We spoke to the best of them, and weâve simplified, clarified, and prioritized their advice on minimizing the risks of dying before your time. For more tips, . Reporting by Sarah Z. Wexler.
As more men deemed to be at genetic risk of prostate cancer opt to have the organ removed preemptively, lesser-known side-effects of the procedure are coming to the fore. In addition to the oft-reported effects of urinary incontinence and impotence following surgery, here are some symptoms more rarely accounted for:
Shrunken penises. As many men are prescribed antiandrogen treatments to block testosterone effects on advanced prostate-cancer tissue, Dr. Celestia Higano of the University of Washington reports that up to 68 percent of men experience penile shortening after radical prostatectomy surgery.
âDry orgasmâor, rather, orgasm without ejaculation, which occurs after surgery when retrograde ejaculation sends semen back into the bladder instead of out the penis.
This article originally appeared in Esquireâs November issue.
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If Youre The Receiving Partner
Youll want to be as relaxed and aroused as possible, because itll make the experience easier and more enjoyable.
The whole poop-comes-out-of-the-butt thing gives some people a case of the heebie-jeebies even when its their own butt.
Remedy this by taking a shower and paying a little extra attention back there to get it squeaky clean. Some people like to use an enema before engaging in butt play, but it isnt necessary.
Use the bathroom before getting started. Prostate stimulation can make you feel like you need to pee, and anal penetration can cause the sensation of needing to poop.
Even though you wont actually do either, worrying that you might can interfere with your ability to let go and enjoy yourself. Knowing your bladder and bowels are empty can help.
Getting used to the sensation of having your prostate touched can help, too. Practice with an anal sex toy, like a butt plug, or your fingers.
Be sure to set the mood so that youre turned on and primed for action. Light candles, watch porn, or engage in some good old-fashioned masturbation or foreplay to get there.
Finally, be sure to lube up real good. Applying a water-based lubricant will allow for easier penetration and make for some easy gliding if stimulating your prostate externally.
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What Happens If Prostate Cancer Comes Back
The prostate is a small gland about the size of a walnut that helps make seminal fluid. Its intertwined with your urinary tract system, resting below your bladder and surrounding the urethra. As you age, this gland continues to grow, sometimes resulting in benign prostatic hyperplasia. While this growth is normal, cancerous growth is not. Cancer occurs when the cells in your prostate gland begin to grow out of control.
While prostate cancer is common, especially among older men, its got a fairly positive outcome. When caught early and treated, most men survive and continue on with remission after five years. Unfortunately, for a small percentage of men, the cancer returns. To give you some clarity on this situation, heres what happens if prostate cancer comes back.
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Types Of Prostate Surgery
There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.
Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.
The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.
Keyhole surgery .
- Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
- Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.
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Can Anything Be Done For Erectile Dysfunction Caused By Prostate Cancer Treatment
Yes, there are things you can try if you have erectile dysfunction after your prostate cancer treatment. You should keep in mind that the following things will affect your ability to have an erection after your prostate cancer treatment:
- How good your erections were before your treatment
- Other medical conditions you have like high blood pressure or diabetes
- Some types of medicines you may take such as medicines for high blood pressure or antidepressants
- Things you do in your life such as drinking or smoking
- Your age
- The type of prostate cancer treatment you had
It is important that you and your partner speak with your doctor or healthcare team about what you can do. Your doctor or healthcare team will speak with you about what might work best for you if you have erectile dysfunction. It is important that you speak with them since some treatments for erectile dysfunction can affect other medical problems you may have.
Types of treatment for erectile dysfunction include:
When To Call Your Doctor Or Nurse
Its important to tell your doctor or nurse if:
- your bladder feels full or your catheter isnt draining urine
- your catheter leaks or falls out
- your urine contains blood clots, turns cloudy, dark or red, or has a strong smell
- your wound area or the tip of your penis becomes red, swollen or painful
- you have a fever
- you feel sick or vomit
- you get cramps in your stomach area that will not go away
- you get pain or swelling in the muscles in your lower legs.
Your doctor or nurse will let you know if you should go to the hospital.
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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.
Ask Your Doctor About Solutions
Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
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Remedies For An Enlarged Prostate
Even if you have an enlarged prostate, that does not mean you must live with the symptoms for the rest of your life. Your doctor might advise one of several approaches to coping with BPH, including lifestyle changes, medication changes, and other treatments. The remedies and treatments available will depend on your own health situation and how disruptive the symptoms have become.
Get Sufficient Exercise
Exercise can improve with your overall fitness, as well as benefit your prostate health. Studies have shown a connection between increased physical activity and reduced risk of BPH, with exercise of any type having some degree of benefit.
Seated activities, such cycling, can put pressure on the perineum and groin. This can lead to numbness or pinched nerves. To avoid these issues, make sure you utilize a wide seat and engage in a variety of activity types.
You can also try Kegel exercises to strengthen your pelvic muscles and reduce urine dribbling. To do these exercises, squeeze the muscles that affect urine flow and then release, repeating several times to train the muscles.
When you head to the bathroom, make sure you slow down. When you relax your muscles and leave time to account for delayed urine and possible dribbling, you’re much more likely to completely empty your bladder. Urine that remains in the bladder because of an enlarged prostate can lead to urinary tract infections or painful bladder stones.
Reduce Caffeine and Alcohol Consumption
Within 30 Days Of Your Surgery
Before your surgery, youll have an appointment for presurgical testing . The date, time, and location will be printed on the appointment reminder from your surgeons office. Its helpful to bring the following things to your PST appointment:
- A list of all the medications youre taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name and telephone number of your healthcare provider.
You can eat and take your usual medications the day of your appointment.
During your PST appointment, youll meet with a nurse practitioner . They work closely with anesthesiology staff . Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
Complete a Health Care Proxy form
If you havent already completed a Health Care Proxy form, we recommend you complete one now. If youve already completed one or have any other advance directives, bring them to your next appointment.
Male Sexual and Reproductive Medicine Program
Do breathing and coughing exercises
Follow a healthy diet
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What Is A Prostatectomy
A common surgical approach to prostatectomy includes making a surgicalincision and removing the prostate gland . This may beaccomplished with either of two methods, the retropubic or suprapubicincision , or a perineum incision .
Prior to having a prostatectomy, it’s often necessary to have aprostate biopsy. Please see this procedure for additional information.
Prostate Cancer: Treatment Advances You Should Know About
Prostate cancer treatment has entered the robotics age. Using advancedrobotic technology, Johns Hopkins surgeons can see the prostate in 3-D,magnifying everything 10 times. Johns Hopkins urologist Mohamad Allaf, M.D., explains what this means for patients, including fewer side effects.
Side Effects From Hormone Therapy
Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.
The severity and length of side effects depend on how long treatment lasts. “If a man has only six months of treatment, their level of testosterone rises again, and they’ll go back to feeling like themselves,” Calvaresi said.
Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. “If we can manage those other side effects, then often that improves mood,” she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.
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