After Prostatectomy: What To Expect
At the hospital : You should expect to be in the hospital for one night. At Johns Hopkins, all rooms on the urology floor are private. Here, nurses help patients get moving shortly after surgery to prevent blood clots and other postoperative risks.
First few days at home : After youre sent home, you might find that regular ibuprofen or acetaminophen will be sufficient pain management for the first few days. If over-the-counter medications arent enough, your doctor can help you with alternatives.
One week after surgery : After your surgery site heals, your catheter will be removed. This is usually seven to 10 days after surgery. This can easily be done at your doctors office. Some people decide to take out their catheter at home. If thats the case, ask your doctor for instructions first.
This is also about the time your surgeon will call you with the final pathology results. He or she will discuss what you should know and whether further treatment is necessary.
One month after surgery : Doctors recommend no strenuous activity or heavy lifting for at least one month after surgery. Most people take off work for three to four weeks. If you work from home, you could return to work sooner.
- Urinary incontinence
- Erectile dysfunction
Recovery from surgery takes time. These side effects are often temporary. However, if they are affecting your quality of life, ask your doctor about options that can help.
Verdict On The Pros And Cons Of The Da Vinci Robotic Surgery
As with any surgery, a patient should think twice about using the da Vinci robotic system if what is necessary is a routine procedure. If you need a hernia repair, gallbladder removal, gastric bypass, or a standard colon surgery, then the complexity of this option might not be suitable for your needs.
On the other hand, the dexterity of the robot with this system may make complex cancer surgeries, the removal of neck or head tumors, and options where a minimally invasive choice is not available easier to manage during and after the procedure.
When evaluating the pros and cons of the da Vinci robot surgery, you will want to look at the key points individually with your doctor. It is your comfort level with this process, along with the experience of your physician, that should guide you toward your final decision.
Da Vinci Prostatectomy Benefits
The da Vinci robotic system offers several advantages over other prostatectomy techniques:
- 3-dimensional high magnification camera with true color
- More precise control of surgical tools, with small hand shaking filtered out
- Reduced surgeon fatigue
- Better control of blood loss, which allows the surgeon to see more clearly during the procedure
- Ability to make cleaner and more refined cuts in the area of the prostate
- Smaller incisions
- Faster recovery, including control of urine
- Shorter hospital stay
Every surgery carries potential risks, including da Vinci prostatectomy. They include:
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When Can I Resume Sexual Activity
Sexual activity will be difficult with the catheter in place. After this has been removed you will be free to undertake sexual activity as you desire, bearing in mind the advice on exercise above. Whether or not your erections will return depends on many different factors. We ask that you take particular note of any erections or feelings you do have and report them on your follow-up appointments to the consulting team. Nearly all men will lose all erectile function in the first few months after surgery while the nerves start to recover .
List Of The Cons Of The Da Vinci Robotic Surgery
1. Some surgeries may require you to be held in an unnatural position.The da Vinci robotic surgery system attempts to keep patients in as natural of a position as possible during the procedure. There are times when access is not possible using the usual method, which means you need to be placed in an unusual position while the surgeon does their work. That means you have the risk of suffering from permanent nerve damage if you are kept in that state for an extended time.
There is also the risk of other physical injuries for some procedures if you are kept in an unnatural state for a long time. These are in addition to the typical risks of surgery that everyone faces when a surgeon needs to intervene for their medical care.
2. Tactile feedback is eliminated through the robotic system.Surgeons do not receive the same levels of tactile feedback when working on a patient when they use the da Vinci system over a manual option. That means there is a slight increase in the risk of an injury if an adjacent organ is hit during the medical procedure. Because equipment is being used instead of the hands of a doctor, there is an increased risk of suffering a burn when choosing this option.
This disadvantage is mitigated through the training process for each doctor and continued with their experience in the operating theater, but it still exists.
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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.
Urinary Problems After Surgery
Leaking urine
Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.
Difficulty urinating
A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.
Watch Pauls story for one mans experience of managing urinary problems after surgery below.
Sexual problems after surgery
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Confused Over Those General Weightlifting Guidelines For Da Vinci Surgery What Exactly Does Heavy Mean After A Prostatectomy
If youve just had a prostatectomy or robotic surgery to treat prostate cancer, youll be told to take it easy for a while following the procedure.
What if previous to the operation, you had a routine of lifting weights?
Or, what if youd like to take up weightlifting for the first time?
The problem with generalized instructions is that theyre open to subjective interpretation.
For instance, Its very easy to pick a 20 lb. box off the floor to move it five feet to another area of the floor.
But its more stressful on the body to raise that same item overhead and put it on a high shelf.
Or, its more strenuous to reach into the backseat of your car to lift that 20 pounds out, vs. simply lifting it a few inches off the floor and setting it aside.
Have you read guidelines saying to lift only at 50 percent capacity? This, too, is open to interpretation.
Suppose prior to your prostatectomy you were deadlifting 250 pounds for repetitions. Half that is 125 pounds: a walk in the park.
But to another man, perhaps an older one whos never weight trained before, 125 pounds will be quite heavy.
Shutterstock/ Ihor Bulyhin
Thus, 125 pounds is out of the question for him, but perfectly fine for the aforementioned individual who already has a trained body.
Patients With A Suprapubic Catheter
- Clamp the suprapubic catheter at 09:00 on the date advised by Prof. Eden using the Flip Flo valve attached to the end of the catheter.
- Release the clamp if you are unable to pass urine or experience abdominal, pelvic or genital pain.
E-mail Prof. Eden at at 16:00 on the same day with the following information:-
- Number of voids e.g. 6.
- Volume of each void in ml e.g. 150 ml, 300 ml, etc.
- Amount of leakage e.g. nil, 1 small pad lightly damp.
- Any other information that you think is relevant.
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What If My Incontinence Persists
When bladder leaks persist more than a year, other treatments may be needed to improve the urinary control.
Though rarely needed, Dr. David Samadi and his team provide a range of treatment options for men experiencing long-term incontinence after prostate surgery.
A variety of surgical procedures can be used to restore urinary control should your symptoms last more than a year.
What Are The Benefits To Patients Who Have Laparoscopic And Robotic Prostate Cancer Surgery
The benefits are similar between robotic and laparoscopic prostate surgery. Patients are usually able to go home the day after prostate surgery, and can return to daily living activities as early as 7-10 days after surgery. Patients undergoing open surgery generally have 4-6 weeks before they can resume routine daily living activities, generally experience less post-operative pain and discomfort and have a faster recovery. They also experience significantly less intraoperative bleeding. Robotic and laparoscopic prostatectomy uses small incisions and is highly precise the risk of incontinence is low and the surgical technique is continuously refined to improve potency.
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What Else Should I Look Out For
If you develop a temperature, increased redness, throbbing, drainage at the site of your operation, increasing abdominal pain or dizziness please contact your GP/ward M4 /on-call Urology specialist registrar immediately. If you have problems with your catheter , ask your GP to contact the on-call Urologist as soon as possible.
If you become unable to pass urine after your catheter has been removed, you should return immediately to hospital for further treatment.
Should I Still Have My Kidney Removed If My Cancer Has Spread
While some evidence suggests that removing the primary cancer in the kidney can extend the life of patients with metastatic kidney cancer, an evaluation needs to be made to determine how risky the surgery would be. If possible, it may be best to have a minimally invasive removal to limit recovery times.
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How Is The Da Vinci Surgery For Prostate Cancer Performed
Sitting at the robots surgical console, the surgeon performs robotic prostatectomy by controlling the device consisting of:
- high-resolution cameras
- micro-surgical instruments.
Powered by state-of-the-art robotic technology, his hand movements are scaled, filtered, and seamlessly translated into the precise movement of the EndoWrist Instruments.
Biopsy: Things You Need To Know
The first thing you should know is that theres still plenty of room for confusion after a . The prostate in a young man is about the size of a walnut with age and it can get bigger think of a lime, or a lemon, or even an orange. Now, imagine that you have about 14 tiny needles each needle has a hollow center, and when it is stuck into the prostate, it takes out a very small core of tissue. Theres a lot of potential to miss any cancer that might be hiding in there.
This is why many men end up getting multiple repeat biopsies, says NYU Stacy Loeb, M.D. This means that you might have a that is elevated. Your doctor orders a , and no cancer is found. But the PSA keeps on creeping up, so your doctor recommends another biopsy, and maybe even another. About a third of men in one study got another biopsy within five years of a negative biopsy, says Loeb. If the PSA is elevated, do we do another biopsy, or what do we do? This is where some of the second-line PSA tests, like the Prostate Health Index or 4K Score, can be helpful.
A urine test, called the PCA3 test, may also be helpful. Unlike the PSA test, which is prostate-specific but not cancer-specific , the PCA3 test targets genes produced by prostate cancer cells.
First, it can hurt. To get to the prostate, the doctor goes through your rectum. With needles. To minimize pain, your urologist may use conscious sedation or an anesthetic called a prostatic block .
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What Exactly Does Heavy Weightlifting Mean
Dr. Michel explains, You may define heavy lifting as anything which would have been heavy for you before surgery.
So if you found bench pressing 155 pounds difficult, you must avoid this, even though this is a warmup weight for many other men.
Even if 95 pounds was challenging, its the challenge thats the issue, not the weight of the bar.
That said, whats just as important as the weight you lift is how you lift it.
Doing exercises that cause you to bear down while you are still recovering from your surgery could have negative consequences.
Bearing down refers to a feeling that you must strain to lift, press or pull the weight load.
This sensation makes you want to grunt, even if you dont actually do it.
It may make it difficult to hold a straight face rather than grimace and squint your eyes.
His face shows that the barbell is too heavy during a prostatectomy recovery.
It might make you feel similar to how you feel when pushing out a difficult bowel movement.
Regardless of the amount of weightyou should not lift an amount that makes you feel any such way.
This applies to any weightlifting move such as an incline dumbbell press, T-bar row or hack squat.
A good, clear guideline is to stick to your warmup loads let your warmup amounts be your working sets.
During your recovery from a prostatectomy, you should not be straining or fighting to complete a set.
The set should have a medium or light feel to it, not a strenuous or intense feel.
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 surgeon’s sophisticated maneuvers.
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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?
Do You Know The Risks Of Open Prostate Surgery
Historically, the only prostate surgery option was open prostatectomy, involving large incisions and post-operative side effects. Using this procedure, the entire cancerous prostate was removed with the risk of:
- excessive blood loss
- long hospital stays
- considerable pain.
Following open prostatectomy, patient activity was limited and often resulted in a loss of bladder control and sexual function after prostate surgery due to the severance of the delicate plexus of nerves around the prostate gland.
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Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or ‘cauterizing’ the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :