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How To Prepare For Prostate Surgery

What Are The Sexual Side Effects After Robotic Prostate Surgery

Video 20 – How to Prepare Your Body for Prostate Cancer Surgery – Mark’s Prostate Cancer Experience

The degree of sexual function after a radical prostatectomy is determined by many factors. These include the patient’s age, how sexually active he was before the procedure, how much the surgical procedure affects the nerves and how sexually motivated he is after surgery. Most men experience at least temporary erectile problems after a radical prostatectomy.

How Does New Robotic Technology Assist The Surgeon During Radical Prostatectomy

The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss. Because of robotic technology, surgeons are able to perform minimally invasive procedures with more precision. Robotic arms remain steady at all times and robotic wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles – positions surgeons would have difficulty reaching otherwise.

How To Prepare For Prostate Cancer Surgery Explained

Patients often wonder how to prepare for prostate cancer surgery. Dr. David Albala explains some simple steps to prepare for prostate cancer surgery. Patients should generally stop any blood-thinning medication 7 to 10 days prior to prostate cancer surgery as your doctor advises. This includes common medications such as Aspirin. Consult your physician in all matters involving medications.

To prepare for prostate cancer surgery, whether its open surgical technique or robotic techniques, is relatively simple and relatively painless for most patients. It includes a clear liquid diet as well as mild agents to relax and clear bowels. Patients are typically not allowed to eat or drink anything after midnight on the day of the surgery to prepare for prostate cancer surgery. The patient will then come in for prostate cancer surgery in the morning or early afternoon. To prepare for prostate cancer surgery, whether its open surgical technique or robotic techniques, is relatively simple and painless for most patients.

David Albala, MD: So, what do you need to do as a patient to prepare for prostate cancer surgery?

The day before patients are having surgery, I like to start them on a clear liquid diet and then I give them a small bowel prep with magnesium citrate, its usually a small bottle of the drink that helps give the intestines a clean out, much like what we do with colonoscopy, but this is typically a much easier prep to do than that patients undergo a colonoscopy.

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Preparing For A Radical Prostatectomy

If youve been diagnosed with prostate cancer, your physician may recommend a radical prostatectomy to completely remove the prostate. Most likely, this means cancer cells have not spread to other parts of your body. For many, a radical prostatectomy procedure can be daunting, but surgically removing the prostate will eliminate the risk that cancer will travel to other areas.

As an industry leader in urological and mens health issues, GBU is committed to helping its patients understand, prepare for, and recover from a radical prostatectomy. GBUs team is here for you and your family, every step of the way.

As with all content on our blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific questions concerning prostate cancer.

As with all major surgeries, there are risks involved with a radical prostatectomy. Understanding the overall process will help to ease your fears and prepare you for potential roadblocks throughout your journey. As always, openly discuss any potential concerns with your GBU team.

Side Effects Of Prostate Surgery

Per Lesion Ultrasound in Prostate Cancer Active Surveillance

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:

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Strengthening The Pelvic Muscles Can Alleviate Side Effects

Oftentimes, urologists are so focused on removing the cancer that not enough time is spent educating patients on what they can do to minimize the negative effects of the surgery. By strengthening the pelvic floor prior to and after prostate surgery, patients can greatly reduce and reverse such effects.

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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How Often Should You Do Kegel Exercises

The Kegels should be 10 repetitions in a row holding each contraction for a count of 10 with a few seconds of relaxing the muscle in between each contraction. Before surgery, doing 4-8 sets of 10 reps every day in the weeks preceding surgery would be helpful. The first few days after the catheter is removed three sets a day can be done. For the remainder of that first week, you should increase to 10 reps every other hour. After that, you can increase to every waking hour. When done correctly you should not squirt urine while tightening or relaxing, become sore, or have a lack of control. If you experience any of these symptoms, please notify our office.

Reportable Signs And Symptoms After Prostatectomy That Require Immediate Medical Attention:

Preparing for Prostate Cancer Surgery
  • Fever of 101°F, swelling, redness or large amount/smelly drainage from abdominal surgical incisions. A little yellowish/bloody drainage is acceptable
  • Nausea, vomiting, unrelieved abdominal distention and pain
  • Significantly large amount of blood with blood clots in urine
  • Significant decrease in urine output and/or inability to urinate
  • Pain or swelling in one leg or calf
  • Chest pain or shortness of breathe

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Within 30 Days Of Your Surgery

Presurgical Testing

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.

Sperm banking

Male Sexual and Reproductive Medicine Program

Do breathing and coughing exercises


Follow a healthy diet

The Importance Of Strengthening The Pelvic Floor Muscles

Numerous studies have shown the benefits of pelvic floor muscle training after prostate surgery in terms of a hastening the recovery of urinary control and significantly improving the severity of the incontinence as well as having a beneficial impact on the recovery of erectile function in terms of the duration and severity of the erectile dysfunction. Because of the potential urinary and sexual side effects of radical prostatectomy, it is a prudent strategy to commit to a program of Kegel pelvic floor exercises both before and after the prostate surgery. It makes sense to become proficient in these exercises proactively before the trauma of surgery, so you go into the operation armed with precise knowledge and awareness of the pelvic floor muscles as well as with their increased strength, tone, power and endurance.

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Going Back To Work After Radical Prostatectomy

The amount of time a patient needs to take off work following a radical prostatectomy will depend on how quickly they recover and how much physical effort their job involves. Patients undergoing open surgery might need a little longer to get back to heavier physical activities than after keyhole surgery.

Prostatectomy: What To Expect During Surgery And Recovery

Figure 2 from Robot assisted radical prostatectomy: how I ...

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.

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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

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.

Open surgery

Pelvic Exercises Before And After Prostate Surgery

The Private Gym Basic Training program strengthens the pelvic floor muscles with a series of progressive Kegel exercises. The patented Complete Training program provides maximum opportunity for gains through its use of resistance equipment. The Private Gym Complete Training program should be used prior to the prostate surgery because of the importance of using resistance to maximize the strength of the pelvic floor muscles in preparation for surgery. The Private Gym Basic Training program should be started once sufficiently healed from surgery, with gradual progression to the resistance equipment of the Complete Training at the appropriate time.

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The Private Gym Pelvic Floor Muscle Training Program

This program gives one the advantages and benefits of pelvic floor physical therapy training, but in a D.I.Y. environment. In many ways, it is like the highly successful P90X® home training program, which I am a big fan of. The Private Gym is the go-to means of gaining pelvic floor muscle proficiency for men who are scheduled for prostate cancer surgery and wish to train in a comfortable home environment with minimal expense. It is a comprehensive, interactive, easy-to-use, medically sanctioned and FDA registered follow-along exercise program that builds upon the foundational work of Dr. Kegel.

The Basic Training program strengthens the pelvic floor muscles with a series of progressive Kegel exercises, while the Complete Training program provides maximum opportunity for gains via resistance equipment. It is recommended that the Complete Training program be used in preparation for prostate surgery because of the importance of using resistance to maximize the strength of the pelvic floor muscles. The Basic Training program can be started once sufficiently healed from surgery, with gradual progression to Complete Training at the appropriate time.

For more details about the results of the clinical trial please visit:

Risks Of Prostate Surgery

B – Preparing for Surgery: Robotic-Assisted Laparoscopic Radical Prostatectomy | City of Hope

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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How Long Does It Take To Recover From Prostate Surgery

Depending on the type of surgery the recovery time after prostate surgery may linger up to several months. This length refers to a complete healing process. Patients may feel better the very day after the surgery but they need to realize that their body will fully recover only after certain period of time.

Facts Every Man Should Know Before Prostate Cancer Surgery

Many men want to know what prostate cancer surgery is like, including what to expect before surgery and what to expect afterwards.

Here are my findings based upon more than 1,000 phone calls to men the day before surgery, almost 700 visits to men the day after surgery and hundreds of calls from men in the weeks following surgery.

  • Most men experience very little surgical pain – probably 80 percent are like me…I had my surgery on a Monday by Friday I was at a graduation party . I got by with only Advil for pain relief. It’s been described as feeling like they did too many sit-ups.
  • Men really fear the catheter. I let them know that they will be asleep when it is put in. They may be like me and sleep very well with it in. Changing bags from a large capacity night bag to a smaller capacity day bag is simple and doesn’t involve removing the catheter. Walking with the day bag catheter is not a problem. Removal of the catheter is usually done in the doctor’s office after the prescribed timeframe and is relatively pain-free.
  • If all goes as planned, you will be walking the night of surgery and then the next day. Most men go home the following afternoon, unless they are otherwise directed by the doctor.
  • Your biggest discomfort may be from gas pains, hence the walking. For a robotic surgery, they have to fill the body cavity with gas to manipulate the equipment. Until we get rid of the gas in the normal way we do, there can be discomfort.
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    Incontinence After Prostate Surgery

    Radical prostatectomy will cause a period of incontinence for most patients. Every patient is different, so do not compare notes. On average, most patients by two months are dry but there are patients that will never leak and some that will take much longer. The leaking can vary and can be influenced by a certain position. Some patients can experience a squirt of urine as a result of a certain position therein or they may experience a lot of leakages where your entire pad is saturated.

    During recovery, you can have urge incontinence so it will be advantageous to urinate before you have a strong urge. Most patients will not leak at night but might have to wake up every hour or two to urinate. For most patients, doing the Kegels is the first and only thing needed to regain control.

    The Kegel exercise builds up the muscles around the bladder opening. It is important that you start these exercises approximately 4 weeks before surgery in an effort to eliminate any incontinence issues after surgery. It needs to be part of your preparation for prostate surgery.


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