Life After A Radical Prostatectomy: A Real
Reposted from Greater Boston Urology.
In October of 2013, Les Cavicchi underwent a radical prostatectomythe removal of the prostate gland. Les had been diagnosed with prostate cancer a month earlier after undergoing a TRUS biopsy.
Less cancer was localized, meaning it was contained within the prostate gland itself. He didnt need further treatment for prostate cancer after the surgery, only regular monitoring of his PSA.
However, Les did suffer from common side effects associated with radical prostatectomies, specifically urinary incontinence and erectile dysfunction.
Q: So lets get right to it: You were dealing with incontinence after your radical prostatectomy?Les: The thing about any kind of prostate procedure is youve got to deal with incontinence. This was a big issue for me for a while. I had purchased padded undergarmentsa whole case of them, because I didnt know how long this was going to last.
Men wonder why this particular side effect happens. The prostate gland is the primary organ for controlling urinary flow in normal physiology. When you are rising frequently during the night, and/or having difficulty starting urination, these are signs that the prostate is beginning to grow in size and interfere with this specific function. Every mans prostate gets larger with age it does not necessarily have anything to do with having cancer. It is a separate reality.
Women dont have a prostate. What do they use? Kegel muscles!
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The Lymphatic System May Be Affected
Some surgeries are known for affecting the lymphatic system: prostate surgery is certainly one of them. Swelling and fluid buildup in the lymph nodes around the genitals and top of the legs is a common side effect of having prostate surgery. This condition is called lymphedema. It sometimes requires additional treatment, including draining procedures, the use of compression bands, and even some medications. The condition can add to the pain that men experience post-surgery and sometimes recurs.
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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Making Decisions About Surgery
Talk to your surgeon about what types of surgery are available to you. Ask about the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery.
The surgeons experience and skill is more important than the type of surgery offered.
Compared to open surgery, both standard laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery. Current evidence suggests that the different approaches have a similar risk of side effects and no difference in outcomes.
Whichever surgical approach is used, a radical prostatectomy is major surgery and youll need time to recover.
Sex After Prostate Surgery
When first diagnosed with prostate cancer, its common for men to wonder what the future will hold. Certainly, a prostate cancer cure is a top priority, but then what?
Dr. David Samadi understands that men want to know:
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Will I have sex after prostate cancer?
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How will sex after prostate cancer be different?
For many men, prostate cancer treatment choice determines these answers.
If you select robotic prostate surgery your chances of enjoying sex after prostate surgery are very high. Robotic prostatectomy is a minimally invasive prostate removal. It is considered one of the best treatment options for prostate cancer due to its success rate and fast recovery rate.
The da Vinci robotic prostate cancer surgery system enables the surgeon to make precise movements. This ensures cancer-removal efficiency and sparing of the nerves and muscles that are responsible for the sexual function.
However, it is absolutely critical to choose a robotic surgeon with a high case volume and extensive prostate surgery experience. The robot does not perform the surgery and technology is no guarantee of success. Enjoying sex after prostate surgery is only possible if the procedure was performed by an experienced, highly-trained robotic surgeon.
Dr. Samadi explains how the preservation of sexual function is possible:
Read Also: Enlarged Prostate Benign Prostatic Hyperplasia
Going Home With A Catheter
You will be discharged from the hospital with a catheter in place to drain urine from your bladder into a bag. The doctor will remove this in the office in five to 14 days. Be sure to clean the catheter where it exits your penis twice a day with soap and water and to empty the bag frequently. The bag should always be positioned lower than your bladder.
On occasion, the catheter may irritate the bladder, causing bladder spasms that can be quite uncomfortable. If these occur, your doctor can prescribe medication that can help. Leakage of urine around where the catheter exits the penis also may occur and can be managed by wearing incontinence pads as described in the next section.
It is normal for your urine to look cloudy for a few weeks after surgery. Occasionally, bleeding may occur around the catheter or be noticed within the urine. This also is common. If you see large clots â more than an inch in length â or if the catheter becomes plugged, contact your doctor. No anesthesia is required for catheter removal, and most patients experience only a little discomfort.
How Do You Find It
Youll need to head south along the back road to find it in a magical place called the anal region.
Although entering through the anus is the most direct way, you can also stimulate the prostate indirectly through the perineum, or taint.
This is the skin that runs underneath the scrotum to the anus.
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Prostatectomy: What To Expect During Surgery And Recovery
If youve been diagnosed withprostate cancer, your doctor will consider many factors before recommending the besttreatment. For many men, that may mean a prostatectomy. In this surgery,doctors remove the entire prostate.
The Johns Hopkins Hospital performs more of these procedures than almostanywhere else in the world. One of the most common questions they hear frompatients: What should I expect after surgery?
Johns Hopkins urologistMohamad Allaf, M.D., explains the surgery and recovery.
Types Of Radical Prostatectomy
The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.
Open prostatectomy
In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus.
Laparoscopic prostatectomy
In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.
Robot-assisted laparoscopic prostatectomy
Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.
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During Surgery For Prostate Cancer
The most common type of surgery to treat prostate cancer is a radical prostatectomy. This surgery involves removing the entire prostate gland along with nearby tissues .
Since the prostate gland normally connects the bladder to the urethrathe tube inside the penisthe surgeon must also reattach the bladder to the urethra once the prostate gland is removed.
A radical prostatectomy can be performed in three different ways:
- Open radical prostatectomy: The surgeon accesses the prostate gland by making a larger incision over the lower abdomen. Less commonly, the prostate is accessed through an incision made between the anus and scrotum .
- Laparoscopic radical prostatectomy: This minimally invasive approach involves accessing the prostate gland by inserting long, thin instruments through several keyhole-size incisions made in the lower abdomen.
- Robotic-assisted radical prostatectomy: With this approach, the surgeon sits at a computer console and manipulates mini robotic arms/instruments to remove the entire prostate gland. Robotic-assisted is the most common way a prostate is removed for cancer today.
Enlarged Prostate Surgical Procedures
Here is a list of enlarged prostate surgery procedures:
- TUIP widens the urethra by making a few small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself.
- TURP surgery is the procedure used for 90% of all prostate surgeries for BPHit is the standard operation.
With TURP, an instrument called a resectoscope is inserted through the penis to remove the excess tissue. It is less traumatic than open forms of surgery.
It has a high risk of retrograde ejaculation, which is when semen works its way back into the bladder instead of coming out the tip of the penis when you come.
Other risks: impotence, incontinence, blood loss, and urinary tract infection. This procedure is now available using lasers.
- Simple or Partial Prostatectomy is the removal of the inner portion of the prostate through an incision in the lower abdomen. This is an invasive surgery used for very large prostate glands to remove the enlarged part of the prostate.
This BPH surgery procedure is open surgery performed while the patient is under general anesthesia.
Read more about BPH and medical procedures here:
Read these industry-funded sites that explain all the different procedures in greater depth. Buyer beware as despite the claims to being superior, many of these private state of the art procedures have not been proven over time to be superior to the standard TURP:
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Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What type of surgery do you recommend for me and why?
- What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
- How many of these operations have you done and how many do you do each year?
- Can I see the results of radical prostatectomies youve carried out?
- What pain relief will I get after the operation?
- How and when will we know whether the operation has removed all of the cancer?
- How often will my PSA level be checked?
- What is the chance of needing further treatment after surgery?
- What is the risk of having urinary problems or erection problems and what support can you offer me?
What Happens After Robotic Prostate Surgery
- Robotic prostate surgery operative time is typically 2-4 hours
- Hospital stay is typically 1-2 days
- Our team will be seeing you on a daily basis during your stay in the hospital and will give you detailed after-surgery instructions prior to your discharge home.
- Foley Catheter typically comes out on day 5 after a cystogram
- Jackson Pratt drain comes out around the time of Foley catheter removal depending on your individual circumstances
- No driving for 7 days after prostate surgery
- No other restrictions in physically activities after surgery – just do what you can tolerate
- Aspirin can be restarted when you are back to eating regular meals
- You will be given Viagra upon the removal of the foley catheter. Typically 50mg a night, increasing to 100mg if no response. This is not given to necessarily induce erections, but to help improve the blood supply to your penis. If you have any heart conditions, your internal medicine doctor needs to clear you before taking Viagra.
- The first PSA check after prostate surgery is at 1 month and then 3-6 months thereafter.
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What Does The Prostate Do
The prostate is a male gland that releases prostate fluid, one of the components of semen.
The muscles of the prostate gland help propel this fluid into the urethra during ejaculation.
It is a muscular gland that is often described as walnut or small apricot-sized.
An enlarged prostate can be a sign of prostate cancer, the third biggest cancer killer.
Reasons For The Procedure
The goal of radical prostatectomy is to remove all prostate cancer. RP isused when the cancer is believed to be confined to the prostate gland.During the procedure, the prostate gland and some tissue around the gland,including the seminal vesicles, are removed. The seminal vesicles are thetwo sacs that connect to the vas deferens , and secrete semen.Other less common reasons for radical prostatectomy include:
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Inability to completely empty the bladder
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Recurrent bleeding from the prostate
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Bladder stones with prostate enlargement
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Very slow urination
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Increased pressure on the ureters and kidneys from urinary retention
There may be other reasons for your doctor to recommend a prostatectomy.
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What Is A Prostatectomy
A prostatectomy is a surgical procedure for the partial or complete removalof the prostate. It may be performed to treatprostate cancerorbenign prostatic hyperplasia.
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.
Why Erectile Dysfunction May Result From Prostate Disease
In the past, it was thought that most cases of erectile dysfunction were psychological in origin, the result of such demons as performance anxiety or more generalized stress. While these factors can cause erectile dysfunction, doctors now think that 70% of the time the problem can be traced to a physical condition that restricts blood flow, hampers nerve functioning, or both. Such conditions include diabetes, kidney disease, multiple sclerosis, atherosclerosis, vascular disease, and alcoholism.
However, some types of prostate disease and treatments may also be responsible.
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How Is The Prostate Removed
Different procedures can be used to remove or resect a portion of the prostate. One procedure is called transurethral resection of the prostate . In this procedure, tissue from the central portion of the prostate is removed to enlarge the size of the urethra in this region. The prostate gland surrounds the urethra just below the bladder, and as it enlarges with age, can cause difficulty with urination. The procedure is safe, but can result in bleeding for several days following the surgery. The bleeding will gradually subside.
When the patient has prostate cancer, a radical prostatectomy is done to remove the entire prostate, the surrounding tissue and lymph nodes. There is significant bleeding associated with this procedure. Again, the bleeding will decrease in a few days following the procedure.
A computer enhanced robotic laparoscopic radical prostatectomy is an advanced procedure that is becoming the treatment of choice for prostate cancer. This procedure involves very precise resection of the gland under microscopic guidance, avoiding nerves and blood vessels. This results in significantly less bleeding than traditional radical prostatectomy.
Sex After Prostate Surgery And Achieving Orgasm
Sex after prostatectomy is an important concern for most men. The total removal of the cancerous tissues is the primary goal, but the quality of life after prostate surgery is also important. Worrying about ED makes men be nervous and anxious when thinking about undergoing radical prostatectomy.
However, whilst most patients focus on erectile dysfunction, orgasm is somehow under-considered. But is it possible to achieve orgasm after prostatectomy? Erections and orgasm are equally important for a healthy sex life.
The good news is that sex after prostate surgery is very possible and enjoyable for most men. This is due to the newest robotic technologies that are nerve-sparing and preserve the sexual function.
Dr. Samadis robotic prostate surgery, SMART Surgery, was explicitly designed to spare the tiny nerve bundles surrounding the prostate in order to preserve sexual potency.
Men who undergo Dr. Samadis robotic prostate surgery have a reasonable chance of regaining complete erectile function for sex after prostate surgery.
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