Benign Enlarged Prostate: What Are The Pros And Cons Of Surgery
Surgery can very effectively reduce the problems associated with a benign enlarged prostate. It is considered if other treatments dont provide enough relief, or if the enlarged prostate keeps causing medical problems such as urinary tract infections. But surgery often has side effects.
Most men who have a benign enlarged prostate arent in urgent need of surgery. They can take their time to carefully consider the pros and cons. There are various possible reasons for deciding to have surgery. For instance:
- The prostate-related problems may be very distressing, and other treatments may not have led to a big enough improvement.
- The enlarged prostate may frequently cause other medical problems, such as recurring urinary tract infections or bladder stones.
- Treatment with medication may not be possible for medical reasons.
The decision will also greatly depend on how the man feels about the potential benefits and harms of a procedure. Although surgery is very effective, it can lead to complications such as ejaculation problems.
Can I Do Or Take Anything To Speed Up Nerve Regeneration
I recommend to my patients that they stimulate themselves 2-3 times a week and take a Viagra tablet at least once a week as well. This encourages nerve regeneration and increases blood flow to the penis. There are three tablets in the same family as Viagra that you can take: Cialis , Levitra and Viagra itself . There is evidence that taking one of these tablets regularly after prostate surgery speeds recovery of potency. All three work by increasing blood flow to the penis, and while they wont give you an erection on their own, they make it easier to get one with stimulation.
Not all patients want to take a tablet for potency and there is no compulsion to do so. Please do be aware that there are common side-effects associated with this increased blood flow, including headaches, facial flushing and indigestion.
Why Is Radical Prostatectomy Done
Radical prostatectomy is a treatment for prostate cancer that prevents cancer from spreading outside the prostate gland. It may cure prostate cancer by removing it completely.
For patients diagnosed with prostate cancer, additional tests may be needed to determine the how far the cancer has spread. These tests help your provider decide if you are a candidate for radical prostatectomy:
Revised Model Of Couples Sexual Recovery After Prostate Cancer Treatment
Based on the findings, we modified our preliminary model . We found that couples experienced not one, but two psychosocial transitions: cancer diagnosis is the first life-altering event, sexual changes after surgery are the second one. Anticipatory grief was reported prior to surgery, while grief related to actual losses was reported after surgery. We discovered that couples capacity to recover sexual intimacy was modified by their pre-existing strengths and vulnerabilities, their capacity to communicate about grief and mourning together and their ability to use positive coping strategies.
Revised Model of Couples Sexual Recovery after Prostate Cancer Treatment
Following Up After Surgery
Because surgery for benign prostatic hyperplasia leaves behind most of the prostate gland, it is still possible for prostate problemsincluding prostate cancer or benign prostatic hyperplasiato develop or return.
After your surgery, it is important to continue having a rectal exam once a year and to have any symptoms checked by your doctor.
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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
What Factors Increase The Chance Of Cancer Recurrence
The likelihood of metastasis occurring increases with higher grade and stage of the cancer as the more aggressive and developed the cancer is, the higher the chance of it breaking out of the prostate. More specifically:
- High Gleason grades
- High clinical stages
- Positive surgical margins .
However, most prostate cancers are cured with surgery. As an example, using my results from operations performed on over 2,300 men with a variety of stages and grades, 96.3% of operations resulted in full cancer cure. Some combinations of minor prostate cancer had a 100% cancer cure rate, but the higher you go, the lower the full cancer cure rate.
The commonest sites of recurrence of prostate cancer following surgery are:
- the prostate bed 80% of recurrence cases
- lymph nodes 15% of cases
- bones 5% of cases.
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Will Nerves Regenerate After Prostate Surgery
- During prostate surgery, doctors try to avoid nerve damage, but surgery always causes some damage to erectile nerves.
- The younger you are and the better the nerve sparing, the higher your odds of regaining erectile function.
- You can take Viagra or Cialis after surgery and self-stimulate to get your erections going again.
During prostatectomy, the nerves that control erections are usually damaged. In most cases, those nerves will regenerate, allowing you to regain erectile function. Full recovery depends on factors such as age, erectile function before surgery, and the ability of doctors to preserve the nerves during surgery.
How Soon Can A Man Resume Sexual Activity After A Retropubic Prostatectomy What Activities Are To Be Avoided And For How Long What Activities Are The Best To Help A Man Start To Regain His Sexuality
I advise patients to begin sexual activity as soon as they are feeling up to it. I advise patients to avoid straining the abdominal muscles for 6 weeks after surgery. The importance of early sexual activity is to increase the blood flow to the tissues of the penis. Therefore, sexual activities that normally would produce sexual arousal and an erection would fulfill this requirement.
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Who Can Be A Decent Candidate For The Surgery
If the cancer is organ confined, then you would be a suitable candidate for the procedure. In other words, a well-differentiated, focal tumor.
In comparison, patients with poorly differentiated or high-volume tumors may not be suitable for nerve sparing prostatectomy.
The goal is to safeguard sexual potency in men as much as possible. But, the preservation will vary depending on the age, clinical cancer stage, and the state of the nerve bundles.
What Do We Know About Potency After A Robitic Prostatectomy
The return of potency is dependent on several factors:
- Previous sexual function before surgery. Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery. It will not improve upon what you already had before surgery.
- Age. Theyounger you are, the better your chances. Men under 65 have abetter chance of regaining potency, or erectile function than those over 65.
- How many nerves are spared. As discussed previously, ideally both nerves can be spared and thiswill give you the highest chance of regain erections. However,even men with no nerve sparing can regain erectile function.
Ejaculation will no longer occur in any patient. This is because the seminal vesicles and the vas deferens , are removed and cut during the surgery. This means that you will no longer be able to father children
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Sexual Performance After Prostate Cancer And Getting Back To Enjoyable Sex After Prostate Surgery Is Possible Heres How:
1. Masturbate solo sex is a great way to help you relax, build confidence, and find out how your body will respond after surgery.
2. Kegel exercises mastering these pelvic floor exercises before surgery can actually improve your orgasm after surgery. They may even help you achieve multiple orgasms. Bonus they help strengthen urinary control, too.
3. Involve your partner remember that sex is best as a team sport so the sooner you work together, the better. Use physical and emotional intimacy to build up to penetration.
4. Stay ahead of Erectile Dysfunction oral medication for ED is a great way to speed sexual recovery. Using prescriptions such as Viagra or Cialis, even for a short time, can give you the confidence and sexual potency you need.
5. Have sex the more sex you have, the more sex youll have. Meaning, penile rehabilitation through touching, intimacy, and erectionpractice will actually get you back in the game faster.
Perineural Invasion: What Is The Significance If Perineural Invasion Is Present And Identified In A Post Op Pathology Report
There are small nerve fibers that pass through the inside of the prostate gland. These nerves secrete a growth factor that attracts prostate cancer cells. Accordingly, in the great majority of prostate cancers, the cancer cells are seen to be lined up surrounding nerve fibers. This is called perineural invasion. Perineural invasion is so common as to almost be a diagnostic feature of prostate cancer. Its clinical significance is that when it is found in a needle biopsy specimen, there is a greater chance that the tumor will be found to have spread outside the prostate gland. If the tumor has spread outside the prostate, there is a higher chance for tumor recurrence. However, if the tumor has not spread outside the prostate gland, there is little or no prognostic significance to perineural invasion.
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What Happens If I Still Cant Have Adequate Erections After My Recovery With Oral Medications
There are several options available in this case. Most of the time it depends on you and your partners goals. Some men manage to have adequate erections with vacuum erection devices, penile injections, and occasionally, urethral suppositories. However, many men prefer the convenience and rigidity that can be achieved with a penile implant. Our clinic can help you choose the ideal option.
What Causes The Penis And Testicles To Draw Up Into The Body 6 Years After Prostatectomy
Men normally have daily erections with highly- oxygenated arterial blood . Even male babies have erections every day. These infusions of well-oxygenated blood into the genital tissues keep these tissues healthy and robust and are critical for the propagation of the human species. Testosterone levels decrease with age, and if men are not having frequent erections, the genital tissues gradually undergo atrophy. This condition can be treated with testosterone- replacement therapy and with treatments that induce erections with arterial blood . I routinely incorporate this type of rehabilitation in my postoperative patients. See my article on erectile rehabilitation after radical prostatectomy in the Spring 2013 QUEST.
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Getting Ready For Surgery
You and your care team will work together to get ready for your surgery. Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if youre not sure.
- I take a blood thinner, such as:
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. Its important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know youre at risk for these problems, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other problems during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
- Be honest with your healthcare providers about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. Tell your healthcare provider right away if you:
- Get a headache.
- For information about being a health care agent, read How to Be a Health Care Agent.
- If you have more questions about filling out a Health Care Proxy form, talk with your healthcare provider.
Male Sexual and Reproductive Medicine Program
Viagra Useful For Impotence Following Prostate Surgery
Nov. 30, 1999 Ã¢ Men with prostate cancer who have their prostate removed are usually free of cancer, but the procedure often comes with a cost Ã¢ impotence. A new study, however, shows that Viagra , the popular medication for erectile dysfunction, can restore impotency lost in surgery. Whether men respond, however, depends on how much nerve damage occurred during surgery.
Each year some 200,000 men are diagnosed with prostate cancer and, of those, 50,000 will have to undergo surgical removal of the prostate.
Ã¢Incontinence and impotence are the two most common side effects. A large number of patients, even with nerve-sparing techniques, end up with erectile dysfunction,Ã¢ Milton Lakin, MD, who leads the medical urology section at Cleveland Clinic Foundation, tells WebMD. Ã¢The first thing want to do is a very good cancer operation. Cancers are being discovered early enough that in many cases it is possible to spare both nerves, or at least one.Ã¢
The new study, which appears in the November Journal of Urology, was completed by physicians at Baylor College of Medicine in Houston. It involved about 80 men who ranged in age from 47 to 76 years old. All were prescribed Viagra following prostate removal surgery. Based on their responses to a series of questionnaires, 53% had improved erections and 40% had improved ability to have intercourse.
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Intracavernosal Injection And Intraurethral Therapy
ICI and intraurethral therapy use alprostadils vasodilation effects to improve EF. Alprostadil delivers prostaglandin E1 which increases the levels of 3′,5′-cyclic adenosine monophosphate within the erectile tissue and result in the efflux of intracellular calcium ions and cavernosal smooth muscle relaxation. Its intraurethral form generally does not cause systemic side-effects, but locally it can elicit urethral burning and penile pain . Trials investigating non-oral and non-pharmacological therapies are summarized in Table 2.
McCullough et al. presented the first randomized, prospective trial to study the effect of intraurethral alprostadil with Medicated Urethral System for Erection . Two hundred and twelve men were randomized into taking nightly IUA or nightly sildenafil for 9 months. IUA was titrated from 125 to 250 µg after 1 month of treatment for better toleration of side effects. At study end, there was no statistically significant difference in the IIEF-EF score or successful intercourse rates. They did note a significant difference between groups in erections, assessed by the global assessment question, at 6 months in favor of IUA . Although compliance rates were 98% and 79% for sildenafil and IUA, respectively, dropout rates approximated 30% for the IUA group secondary to pain experienced after the increase in IUA dosage.
Sex After Prostate Surgery And Achieving Orgasm
Sex after prostate surgery 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. Restoring the sexual function after prostate surgery is essential to enjoying life to the fullest!
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.
First of all, bear in mind that the radical prostatectomy is the surgery performed to remove the prostate gland and sourrounding affected tissue. This is the most recommended treatment for prostate cancer. However, many men wonder if they would be able to have sex after prostate surgery as they did before.
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Technique Shows Potential In Restoring Erectile Function After Cancer
We were unable to process your request. Please try again later. If you continue to have this issue please contact .Christopher Coombs
A minimally invasive surgical technique restored erectile function among most of a small cohort of men who underwent radical prostatectomy for prostate cancer, according to study results.
We looked at sexual quality of life before and after ,Christopher Coombs, MD, MBBS, FRACS, clinical professor at the University of Melbourne, and plastic surgeon at Southern Plastic Surgery in Australia, said in a press release. Regaining erectile function had a significant impact on quality of life and the way the men felt about themselves.
The analysis included 17 men with severe or moderate post-prostatectomy erectile dysfunction. All men had undetectable PSA levels and underwent the minimally invasive technique, end-to-side nerve grafting, between March 2015 and October 2017.
Results showed the procedure was safe and resulted in an overall 71% success rate.
Coombs told HemOnc Today about the study, why he and his colleagues thought this technique could work, and what is next for research.
Question: What prompted this research?
Q: What was the rationale for why this technique may work?
Q: How did you conduct the study?
Q: What did you find?
Q: What is next?
Q: Is there anything else that you would like to mention?
For more information: