Who Should Undergo Radical Prostatectomy
Men younger than age 75 with limited prostate cancer who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.
Before performing radical prostatectomy, doctors first try to establish that the prostate cancer has not spread beyond the prostate. The statistical risk of spread can be determined from tables comparing the results of a biopsy and PSA levels. Further testing for spread, if needed, can include CT scans, bone scans, MRI scans, and ultrasound.
If it appears that the prostate cancer has not spread, a surgeon may first offer other options besides surgery. These can include radiation therapy, hormone therapy, or simply observing the prostate cancer over time, since many prostate cancers grow slowly. Depending on how high the risk of cancer spread, pelvic lymph node dissection may be considered, as well.
The Morning Of Your Surgery
Instructions for Drinking Before Your Surgery
You can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take Your Medications As Instructed
A member of your care team will tell you which medications to take the morning of your surgery. Take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower With a 4% CHG Solution Antiseptic Skin Cleanser
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Do not put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Dont wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Dont put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
- Leave valuable items at home.
What to bring
Once youre in the hospital
Get dressed for surgery
When its time to change for surgery, youll get a hospital gown, robe, and nonskid socks to wear.
Meet With a Nurse
Diet Fluids And Bowel Movements
Constipation is a common side effect of pain medications and surgery. You should have received prescriptions for an oral stool softener and a laxative.
You should start drinking fluids as soon as you are comfortable after surgery, and you can resume your normal diet the first day after surgery. But while waiting for normal bowel function to return, you should avoid large meals in favor of several small meals a day. To prevent constipation, we recommend drinking at least eight to 10 glasses of fluids each day and eating lots of fruits and vegetables. Avoid carbonated beverages and cruciferous vegetables such as broccoli, cauliflower, brussels sprouts and cabbage for approximately two weeks, as they frequently cause gassy discomfort and distention.
Take your stool softener and laxative as prescribed. Normal trajectory for return of bowel function is one to two days to pass gas, three to five days for the first bowel movement.
If you haven’t had a bowel movement by day three after your surgery, take oral Miralax , an over-the-counter laxative. You can combine Miralax with the prescribed stool softener and laxative. Follow the instructions on the box. Do not use any enemas or take stronger laxatives, such as magnesium citrate. Contact the clinic if you still haven’t had a bowel movement by day five.
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What Are The Risks Of Robotic
As with any major surgery done under general anesthesia, there is a certain amount of risk, including heart attack, stroke and death. Preoperative assessment of a patients overall health is part of the surgical workup at UC Davis. Prostatectomies, including those done with a robotic-assisted surgery system, are also associated with the risks of impotence and incontinence.
How Long Does Erectile Dysfunction Last After Prostate Surgery
Is erectile dysfunction a possibility after prostate surgery?
Many patients are concerned about it and prefer other prostate cancer treatments.
However, they should know that most erectile issues are temporary and improve after a while.
These patients usually recover from this problem after a few months.
In this article, we cover sexual function after prostate cancer surgery thoroughly, tell you how long ED can last, and how to cope with erectile problems.
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How To Prepare For Your Surgery
Your urologist or doctor will give you specific instructions to prepare for your surgery. Typically, they will want to send you for a few diagnostic tests, like blood draws or X-rays, to verify your general health prior to surgery. Your doctor will also advise if you need to stop taking any of your normal medications.
Dont make any sudden changes without first consulting your doctor. However, there are several easy lifestyle changes you can start doing right now to help your surgery go smoothly and speed up your recovery time.
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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Prostate Cancer Treatment Begins With Your Primary Physician
In most cases once youve been diagnosed with prostate cancer, your primary care physician and/or urologist will assist you with the necessary tests required before prostate surgery. This should be done approximately four weeks before surgery. If you have any questions regarding pre-operative tests please email us or call at .
Urinary Incontinence After Prostate Surgery: Everything You Need To Know
Undergoing a prostatectomy can be difficult. And for many men, finding that they are incontinent post surgery may come as a shock.
But rest assured that there are many treatments available to manage incontinence treatment after surgery. Read below for some of the most common questions we receive about incontinence after prostate surgery.
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Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
Dealing With Erectile Dysfunction After Surgery
On the other hand, a man with erectile dysfunction cannot achieve and maintain an erection for sexual penetration. Two tiny bundles of nerves on the sides of prostate control erections.
If a patient has erections before surgery, the surgeon will attempt not to injure those nerves. In other words, they will use a nerve-sparing technique. However, if cancer affects areas close to the nerves or is growing into them, the surgeon will have to remove those nerves as well.
Upon removal of both nerves, a man is unable to achieve a spontaneous erection. That doesnt mean they will never have an erection, though. Today, several aides can help a man achieve an erection.
Its useful to mention a patient may have erections when nerves on one side of the prostate are removed only. In case a surgeon doesnt remove any nerves, you have a good chance of restoring healthy erectile function. Keep in mind this may take a while.
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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:
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
- 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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Surgically Removing The Prostate Gland
A radical prostatectomy is the surgical removal of your prostate gland. This treatment is an option for curing prostate cancer that has not spread beyond the prostate or has not spread very far.
Like any operation, this surgery carries some risks.
A recent trial showed possible long-term side effects of radical prostatectomy may include an inability to get an erection and urinary incontinence.
Before having any treatment, 67% of men said they could get erections firm enough for intercourse.
When the men who had a radical prostatectomy were asked again after 6 months, this had decreased to 12%. When asked again after 6 years, it had slightly improved to 17%.
For urinary incontinence, 1% of men said they used absorbent pads before having any treatment.
When the men who had a radical prostatectomy were asked again after 6 months, this had increased to 46%. After 6 years, this had improved to 17%.
Out of the men who were actively monitored instead, 4% were using absorbent pads at 6 months and 8% after 6 years.
In extremely rare cases, problems arising after surgery can be fatal.
Its possible that prostate cancer can come back again after treatment. Your doctor should be able to explain the risk of your cancer coming back after treatment, based on things like your PSA level and the stage of your cancer.
Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when it’s half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
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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:
- https://www.cancerforums.net/forums/14-Prostate-Cancer-Forum
- http://community.prostatecanceruk.org/
- http://www.topix.com/forum/health/prostate-cancer
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.
Urination And Incontinence In The Postoperative Period
People who have undergone a prostatectomy will be taught how to operate the catheter before they leave hospital after the operation. The operation of most catheters is relatively similar and involves collecting the urine in a drainage bag, which can then be emptied into the lavatory. The drainage bag must be changed at appropriate intervals.
All men normally experience some level of incontinence after the catheter has been removed, particularly after involuntary bodily actions such as sneezing or laughing. It is also common to experience sudden impulses to urinate while the catheter is in place. This is called a bladder spasm. Bladder spasms should ideally not be particularly painful or occur very often. Therefore, it is wise to consult the doctor if they occur frequently enough to be bothersome or are accompanied by acute pain.
For most men, urinary problems are temporary and are effectively resolved by practicing pelvic floor and Kegel exercises regularly, as recommended by the doctor. Pads should be worn whilst urinary leakage is occurring and changed throughout the day as needed.
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Life After Treatment: Alan Weiners Story
When Alan Weiner found out he had prostate cancer, it was a huge and frightening emotional bomb blast.
The New York native was diagnosed in February 2014 at age 69. After seeking out opinions from various doctors, Weiner underwent robotic prostatectomy in April at Mount Sinai Hospital in New York.
Because of the emotional toll his diagnosis took, Weiner says he found a support group that helped him through that uncertain time in his life. I joined Gildas Club after surgery, but if I had known about it, I would have attended sessions prior to deciding treatment, he says. I found a friend who went through the process and was understanding of my anxieties, fears, and projections.
I never thought that the emotional aspects of this would be so difficult to deal with, Weiner adds. I never believed that the mortality rate of prostate cancer was very low, and I believed that I would be the one who would not make it. I now know that my fears and negative thinking were things most men go through, however.
Today, Weiner goes for routine checkups, and two years after his initial diagnosis, his PSA level is undetectable. He deals with persistent sexual dysfunction, but the bladder control issues he first experienced after his surgery have resolved.
About Your Prostate Surgery
A radical prostatectomy is a surgery to remove your entire prostate gland and seminal vesicles. Some of the lymph nodes in your pelvis are removed as well. This is done to prevent cancer from spreading from your prostate to other parts of your body.
A radical prostatectomy can be done in 1 of 2 ways. One way is through an open incision , which is called an open prostatectomy. Another way is to use a laparoscope, which is a tube-like instrument with a camera. Your surgeon will talk with you about the best surgery option for you.
Open prostatectomy
In an open prostatectomy, your surgeon will make an incision that goes from your pubic bone towards your belly button . Theyll remove the pelvic lymph nodes first, followed by the prostate gland, and then the structures next to it.
Figure 2. Open prostatectomy incisions
Laparoscopic or robotic-assisted prostatectomy
During a laparoscopic or robotic-assisted prostatectomy, your surgeon will make several small incisions in your abdomen . Theyll insert a laparoscope into 1 of the incisions and use gas to expand your abdomen. Surgical instruments will be inserted into the other incisions to remove the prostate. Some surgeons at MSK are specially trained to use a robotic device to assist with this procedure.
Figure 3. Laparoscopic or robotic-assisted prostatectomy incisions
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