What Is A Robotic Or Laparoscopic Radical Prostatectomy
Now routine procedures at Cleveland Clinic, laparoscopic or robotic prostatectomy are minimally invasive surgery procedures used to remove the prostate. Both forms of surgery are now routinely offered at the Cleveland Clinic to patients with prostate cancer. Our single-institution experience now exceeds 1000 cases of laparoscopic and robotic prostate surgery performed.
Treatment For Intermediate Risk Prostate Cancer
Intermediate risk prostate cancers are the most frequently treated prostate cancers. They are cancers that are confined to the prostate, often are Gleason 7 and have a PSA of less than 20. These cancers are treated in men with life expectancy greater than 10 years to prevent spread of the cancer in the long-term. There are a number of different effective treatment options for intermediate risk prostate cancer and the decision is often a personal one. Here at UCLA we recommend consultation with both Urologist and Radiation Oncologist to help men decide which treatment option is best for them.
Transurethral Resection Of The Prostate
This operation is more often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia . But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.
During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra . The skin is not cut with this surgery. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia or general anesthesia is used.
The operation usually takes about an hour. After surgery, a catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.
You will probably have some blood in your urine after surgery.
Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.
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Types Of Radical Prostatectomy
There are three main types of radical prostatectomy:
- Retropubic. In this procedure, the surgeon uses an incision in the lower abdomen to remove the prostate and the lymph nodes for examination. This procedure allows for a nerve-sparing approach, which can lower but not totally eliminate the risk of impotence following surgery. In the nerve-sparing approach, the surgeon tries to preserve one or both of the small nerve bundles needed for unassisted erections. However, if the cancer has spread to the nerves, this approach may not be advised.
- Laparoscopic. In this recently developed procedure, the prostate is removed in a fashion similar to a retropubic prostatectomy, but the procedure is performed through five very small incisions using lighted, magnified scopes and cameras. The prostate specimen is then removed in a small bag through one of the incisions, which is expanded to 2 to 3 cm to allow specimen removal.Potential benefits of this procedure are less pain and earlier return to full activities. Nerve-sparing methods and lymph node dissections can be performed with this technique as well.
- Perineal. In this procedure, the prostate is removed through an incision in the skin between the scrotum and anus. The lymph nodes can’t be removed through this incision. If the lymph nodes need to be examined, removal can be done through a small abdominal incision or by a laparoscopic procedure. A nerve-sparing approach can be performed perineally.
Side Effects From Radiation
Urinary symptoms from radiation treatment for prostate cancer are different from those caused by prostate surgery. “It’s more like a urinary tract infection-increased urgency and frequency, and men may some have bleeding or pain when they urinate,” Calvaresi said. These problems often go away once treatment is complete.
Radiation also may cause bowel changes, such as constipation, loose stools or both. These can be managed by over-the-counter medication. Men may also see some blood in their stool during treatment-if so, let your health care provider know about this.
Men undergoing radiation are likely to have ED, but not immediately. “It slowly sets in after radiation treatment,” Calvaresi said. Treatments for radiation-related ED are the same as ED caused by prostate cancer surgery.
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What To Expect After Surgery
A prostatectomy is major surgery from which your body needs time to recover. Your doctor will discuss the details of your recovery with you.
Typically patients stay in the hospital overnight after surgery and then need to recuperate at home for a month before returning to work. Most men can start to drive a few weeks after surgery. You should avoid heavy lifting for several weeks after surgery. It usually takes about six weeks for most men to feel back to normal.
This page provides general information about what you can expect in the first hours and days right after surgery. You may also want to read more about:
S To Recover Orgasm And Potency After Prostatectomy
The key to enjoying sex after prostate surgery is to start when youre ready. Dr. Samadi and his knowledgeable team are available to support you and your partner as you work to resume sexual activity.
Sex After Prostate Surgery Getting Started
- Masturbate:This helps you learn how your body will respond to stimulation after surgery and builds your sexual confidence.
- Kegel exercises:Try out pelvic floor exercises to improve orgasm and urinary control.
- Involve your partner:
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How Fast Will I Become Totally Continent After Prostate Surgery
During surgery for prostate cancer, the urethra is also affected and, depending on the experience of the surgeon, more or less of the continence function will be preserved. Due to the high precision of robotic surgery, the patient will have a catheter for roughly one week and the trauma to the urinary function will be minimum.
The discomfort that patients feel during this time is minimum, but you should expect the removal to make you feel uneasy. The catheter will be removed during a visit to your doctor, so do not try to do this at home, as it could cause infections. The degree of which the urinary function will be affected depends on how normal the function was before surgery, age and weight.
It is worth noting that most men will experience some degree of incontinence after prostate surgery, but control can be regained within several weeks or months to a year.
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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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What Causes Prostate Cancer
Prostate cancer affects mainly older men. About 80% of cases are in men over 65, and less than 1% of cases are in men under 50. African American men and those with a family history of prostate cancer are more likely to get it.
Doctors donât know what causes prostate cancer, but diet contributes to the risk. Men who eat lots of fat from red meat are most likely to have prostate cancer. Eating meat may be risky for other reasons: Meat cooked at high temperatures produces cancer-causing substances that affect the prostate. The disease is much more common in countries where meat and dairy products are common than in countries where the diet consists of rice, soybean products, and vegetables.
Hormones also play a role. Eating fats raises the amount of testosterone in the body, and testosterone speeds the growth of prostate cancer.
A few job hazards have been found. Welders, battery manufacturers, rubber workers, and workers frequently exposed to the metal cadmium seem to be more likely to get prostate cancer.
Not exercising also makes prostate cancer more likely.
Drugs that may lower the risk of prostate cancer include aspirin, finasteride , and dutasteride .
What Factors Influence Cancer Predictions If The Psa Level Is Elevated
As previously noted, PSA rising after surgery can mean many different things in terms of the status of prostate cancer. These different prognoses are based on several different factors, outlined below:
- Gleason Score of Prostate Cancer: The Gleason score is a measure of how aggressive the cells of prostate cancer are. The higher the score, the more aggressive cancer. Men with higher Gleason scores who experience PSA recurrence are at greater risk for metastasis of prostate cancer than those men with lower Gleason scores. Is the Gleason Score 7 or less or is it 8 or higher?
- Time from Surgery: How soon after surgery the PSA reappears is one indicator specialists use to determine the aggressiveness of cancer. Generally, the longer the time between surgery and PSA recurrence, the less likely cancer is aggressive and going to spread. In turn, the better rate of survival will be. Is the time greater or less than 2 years?
- PSA Doubling Time: The term refers to the time it takes for the PSA to double in value. The value measures the rate at which the PSA rises, and can be a very significant indicator of the aggressiveness of cancer. Men with a shorter PSA doubling time postoperatively are more likely to have more aggressive disease. In these cases, a more aggressive secondary treatment plan may be advised. Is the PSA doubling in less or greater than 10 months?
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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.
How Does The Procedure Work
After anesthesia, a surgeon will insert a tool called a resectoscope into the urethra. In some cases, a separate device will be used to flush sterile fluid through the surgical site.
Once the surgeon has positioned the resectoscope, they will use it to cut away abnormal prostate tissues and seal broken blood vessels.
Finally, the surgeon will insert a long plastic tube called a catheter into the urethra and flush destroyed prostate tissues into the bladder where they are excreted through urine.
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Are There Differences Between Orp Lrp And Ralrp
According to a 2010 of different surgery types for prostate cancer, the outcomes for open radical prostatectomy , laparoscopic , and robotic-assisted prostatectomy are not significantly different.
But people who choose LRP and RALRP may experience:
- less blood loss
- shorter hospital stay
- faster recovery time
Also, people who choose RALRP report faster recovery in continence and decreased hospital stay, in comparison to LRP. But the overall outcomes still depend on the surgeons experience and skill.
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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Radiation Therapy For Prostate Cancer
Radiation therapy for prostate cancer involves the use of high-energy beams or radioactive seeds to eliminate tumors, provided by specialty doctors in the fields of urologic oncology and radiation oncology. Early-stage prostate cancer can often be successfully treated with a non-surgical option such as prostate radiation therapy. At UCLA, the most common types of radiation therapy offered for men with prostate cancer are brachytherapy, external beam radiation therapy, image-guided radiation therapy , and stereotactic radiotherapy.
Does Viagra And Cialis Work After Prostate Removal
During recovery, medications like Viagra and Cialis will help. Viagra can restore impotence and contributes to more pleasurable sex life.
A study published in the Journal of Urology reported that 53% from a total of 80 men who underwent radical prostatectomy had their erection function restored after taking Viagra.
But is Viagra an addictive drug?
Many men experienced a high rate of improvement in their sexual performance due to medications such as Viagra, Cialis, or Levitra. If you have been wondering whether these medications are addictive, you should know that the active ingredient in Viagra, sildenafil, is not an addictive substance.
These medications work by increasing the blood flow to the penis and facilitate the erection process. Addiction is brain-triggered, but Viagra does not target the nervous processes in the brain. That is why it is considered a safe option for those who want to faster recover their sexual potency after prostate cancer treatment.
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When To See A Doctor
Most people begin to feel better and have an improved urine flow within 4 to 6 weeks after TURP surgery.
Overall, the risk of serious complications after TURP surgery is quite low. But as with all surgeries, there are some potential health risks associated with the procedure that require medical attention and intervention.
Reasons to seek medical attention after TURP surgery include:
- bleeding from the urethra, outer prostate, or penis
- inflammation and pain in the urethra, prostate, or penis lasting longer than 2 weeks or worsening
- reduced urine flow or urinary symptoms, such as incontinence or urinary urgency 6 weeks post-surgery
- blood in the urine that is severe or lasts longer than 4 to 6 weeks
- severe clots of blood in urine or urine that is entirely red
- weakness and fatigue that does not improve after 4 weeks
- impotence or erectile dysfunction
Why Would You Have Surgery For A Benign Prostate Condition
The prostate is the walnut-sized gland that surrounds the urethra in a male. The urethra is the tube that carries urine from the bladder to outside the body. One of the non-cancerous conditions that can affect the prostate is called benign prostatic hyperplasia , which is also known as enlarged prostate.
BPH is the most common prostate problem in men over age 50. About half of men in their 50s and as many as 90% of men in their 70s and 80s have enlarged prostates.
Enlarged prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:
- An inability to urinate.
- Excessive blood in the urine.
- Bladder stones.
- Kidney damage.
Prostate cancer and infertility arent symptoms or causes of BPH. Benign prostatic hyperplasia doesnt cause erectile problems.
Prostate procedures for BPH range from minimally invasive treatments to more extensive surgeries. Your healthcare provider will help you decide which type of prostate surgery is best for you.
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Coping And Support For You And Your Family
Coping with the side effects of prostate cancer surgery can be difficult. There are things you can do, and people who can help you and your family to cope.
Radical prostatectomy for localised prostate cancerUpToDate, June 2016
Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial. EJohansson, and othersThe Lancet Oncology, 2011. Vol 12, Issue 9, Pages 891-899
Sexual dysfunction following radical prostatectomyC.R Benson, and othersJournal of Andrology, 2012. Volume 33, Pages 1143-1154
Quality of life and satisfaction with outcome among prostate-cancer survivors. M. Sanda and othersNew England Journal of Medicine, 2008. Volume 358
Guidelines on Prostate CancerEuropean Association of Urology , March 2015
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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