What You Need To Know About Prostate Surgery
What is prostate surgery for?
The prostate is a gland located underneath the bladder, in front of the rectum. It plays an important role in the part of the male reproductive system that produces fluids that carry sperm.
Surgery for partial or complete removal of the prostate is called a prostatectomy. The most common causes for prostate surgery are prostate cancer and an enlarged prostate, or benign prostatic hyperplasia .
Pretreatment education is the first step to making a decisions about your treatment. All types of prostate surgery can be done with general anesthesia, which puts you to sleep, or spinal anesthesia, which numbs the lower half of your body.
Your doctor will recommend a type of anesthesia based on your situation.
The goal of your surgery is to:
- cure your condition
- maintain the ability to have erections
- minimize side effects
- minimize pain before, during, and after surgery
Read on to learn more about the types of surgery, risks, and recovery.
The goal of prostate surgery also depends on your condition. For example, the goal of prostate cancer surgery is to remove cancerous tissue. The goal of BPH surgery is to remove prostate tissue and restore the normal flow of urine.
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.
What Are The Risks And Complications Of The Male Sling Procedure
Complications are rare with the male sling procedure. However, if complications do occur, they can include:
- Inability to urinate This is the most common problem after surgery, and may require catheter reinsertion for another week or two. In very rare cases, a second surgical procedure may be needed to resolve this issue.
- Bleeding and infection This is a rare complication.
- ErosionThis is a rare complication.
- Recurrent leakage of urine
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What Is The Male Sling Procedure
In the male sling procedure, synthetic mesh-like surgical tape is positioned around part of the urethral bulb, slightly compressing the urethra and moving it into a new position. The urethra is the tube through which urine exits the body. This procedure helps many patients with urinary incontinence.
Does Incontinence Happen If I Treat Prostate Cancer With Radiation
Some men need radiation therapy after prostate removal. During radiation therapy, some of the normal tissues around the urinary sphincter, urethra, and bladder may be exposed, causing irritation to occur post-therapy, leading to incontinence. This typically subsides within a few months after radiation therapy, however, if it persists, additional treatments described below may be helpful.
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Does Incontinence Go Away On Its Own After Prostate Surgery
For most men, urinary incontinence will go away within about 1 year. The time frame varies depending on how severe your incontinence is, and what types of treatments youre using to manage it. Some men may recover from leaks within weeks, whereas others will take months for the bladder leaks to subside. Performing pelvic floor exercises, also known as Kegels, which help strengthen the muscles that are located in the base of the pelvis between the pubic bone may help to speed the recovery process along.
How Is The Male Sling Procedure Done
During the male sling procedure, an incision is made through the perineal tissue . The surgeon will then expose the urethra and use a supportive sling around part of the urethral bulb that covers the most upper part of the urethra close to where it enters the area of the urethral sphincter. By wrapping the surgical tape around the urethral bulb, the sling gently moves the urethra into a new position and increases resistance in this area. This lends support to the bladder neck. This procedure has been shown to help with mild to moderate urinary incontinence, and is most commonly used after radical prostatectomy.
The male sling procedure is usually performed as an outpatient surgery. However, there are some cases where patients will need to stay in the hospital overnight after surgery. The sling support requires absorbable sutures in the perineum . This may cause some pain right after surgery, but overall, the amount of pain is usually mild and well tolerated.
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Risks Of Prostate Surgery
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.
Why Do Prostate Cancer Treatments Cause Urinary Incontinence
It helps to know a bit about how the bladder holds urine. When urine is emptied into the bladder from the kidneys, it is stored inside the bladder until you have the urge to urinate. The bladder is a hollow, muscular, balloon-shaped organ. Urine flows out of the bladder, and leaves the body through a tube called the urethra. Urination happens when the muscles in the wall of the bladder contract, forcing urine out of the bladder. At the same time, muscles that surround the urethra relax and allow the flow of urine. The prostate gland surrounds the urethra. Because an enlarged prostate gland can obstruct the urethra, it can cause urination retention or other problems with urination.
Removing the prostate through surgery or destroying it through radiation can disrupt the way the bladder holds urine and can result in urine leakage. Radiation can decrease the capacity of the bladder and cause spasms that force urine out. Surgery can, at times, damage the nerves that help control bladder function.
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Is Incontinence Normal After Prostate Surgery
Bladder leakage after prostate removal is not all that uncommon and typically will go away after your body begins to heal and your muscles regain strength. Approximately 6-8 percent of men who have had surgery to remove their prostate will develop urinary incontinence. The good news is that most men will eventually regain bladder control with time.
What Causes Incontinence After Prostate Surgery
Urinary incontinence is a potential side effect of prostate removal surgery. The prostate is located just below the bladder and surrounds the urethra. Removing it , or using radiation to treat it, can sometimes cause damage to the nerves and muscles of the bladder, urethra, and or sphincter, which controls the passage of urine from the bladder. This can result in urinary incontinence. In this instance, men are usually experiencing stress urinary incontinence, which is a type of incontinence that happens when you place increased pressure on the bladder. Things like sneezing, coughing, working out, and even standing up can cause you to leak urine.
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Are There Differences Between Orp Lrp And Ralrp
According to a 2010 of different surgery types for prostate cancer, the outcomes for open radical prostatectomy , laparoscopic , and robotic-assisted prostatectomy are not significantly different.
But people who choose LRP and RALRP may experience:
- less blood loss
- shorter hospital stay
- faster recovery time
Also, people who choose RALRP report faster recovery in continence and decreased hospital stay, in comparison to LRP. But the overall outcomes still depend on the surgeons experience and skill.
What Is An Artificial Urinary Sphincter And How Does It Help With Urinary Incontinence
An artificial urinary sphincter can help men who have moderate to severe urinary incontinence due to poorly functioning muscle or sphincter valve after prostate cancer surgery.
The AUS has three parts:
- An inflatable cuff that is placed around the upper urethra. The cuff closes off the urethra to prevent leakage of urine.
- A pump that is inserted into the scrotum. It’s completely on the inside and not visible, and the pump controls the opening and closing of the cuff.
- A small pressure-regulating balloon that is placed in the abdomen, under the muscles. The balloon maintains fluid under pressure within the urethral cuff to pressurize the system and hold urine back.
If you have this surgery, youll press on the pump when you feel the need to pee. This opens the cuff to allow urine to pass. When youre done peeing, the cuff automatically closes again on its own.
The AUS procedure provides a very good and satisfactory result in 90% of cases. Risks are uncommon and include:
- Failure of the device .
- Erosion of the cuff into the urethra.
All of these would require additional surgery.
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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.
How Can I Improve Incontinence After Prostate Surgery
Want to stop incontinence after prostate surgery? Kegels may be your answer! As mentioned above, Kegels are a common treatment option for incontinence after prostate surgery. Among other things, the pelvic floor muscles help control bladder and bowel function and, like other muscles of the body, if they get weak they are no longer able to do their job effectively. To improve muscle function, Kegels must be done regularly, every day. The good news is that they can be performed pretty much anywhere, anytime, and in a variety of positions . For a complete guide on performing a mens kegel, click here.)
Biofeedback can sometimes be used to determine if you are performing a kegel properly. And, electrical stimulation may also be used to help re-teach the muscles to contract.
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Are There New Techniques That Reduce The Chance Of Becoming Incontinent
When removingthe prostate, surgeons try to save as much of the area around the bladder and the sphincter muscles around the urethra as possible, thus limiting damage to the sphincter. Doctors have also fine-tuned the process of placing radioactive seed implants, using sophisticated computer projections that allow the seeds to destroy the prostate while limiting damage to the bladder.
Still, at this point, any man who is undergoing radiation or surgery to treat prostate cancer should expect to develop some problems with urinary control. With newer techniques, some men will have only temporary problems controlling their urine, and many will regain full control of their bladder in time.
Peer Review And Document Approval
An integral part of the guideline development process at the AUA is external peer review. The AUA conducted a thorough peer review process to ensure that the document was reviewed by experts in the treatment of IPT. In addition to reviewers from the AUA PGC, Science and Quality Council , and Board of Directors , the document was reviewed by representatives from AUA and SUFU as well as external content experts. Additionally, a call for reviewers was placed on the AUA website from January 14-28, 2019 to allow any additional interested parties to request a copy of the document for review. The guideline was also sent to the Urology Care Foundation to open the document further to the patient perspective. The draft guideline document was distributed to 49 external peer reviewers. All peer review comments were blinded and sent to the Panel for review. In total, 33 reviewers provided comments. At the end of the peer review process, a total of 476 comments were received. Following comment discussion, the Panel revised the draft as needed. Once finalized, the guideline was submitted for approval to the AUA PGC, SQC and BOD as well as the governing bodies of SUFU for final approval.
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Biofeedback For Incontinence After Protatectomy
Biofeedback is a widely used technique that helps people understand how to control their body functions, including the urinary control. It has proved its efficiency in helping many men regain their urinary control.
Biofeedback therapy uses computer graphs and audios to make it easier for you to locate the muscles you a are working on. It is a teaching tool that instructes you how to strengthen your muscles.
A Patients Story: Overcoming Incontinence
Christopher Miller* is a real estate agent who is married and has two sons. About five years ago, at age 56, Mr. Miller was diagnosed with prostate cancer. After a great deal of research and consultations with five doctors, Mr. Miller decided to have a radical prostatectomy.
Although he considers the operation a success, in that it has apparently eradicated the cancer, Mr. Miller struggled for almost two years to overcome persistent urinary incontinence. For much of that time, he felt ill-served by the medical community. The story of how he eventually overcame this problem may be helpful to other men in the same situation.
What was going through your mind when you learned you had prostate cancer?
Like anyone else, I was surprised. You never think its going to happen to you. The biggest fear, of course, is that it might be life-threatening. Even though I knew this is generally a disease that takes a long time to grow, I still wondered how much longer I might have to live. So I thought of things like: Is my family provided for? Are my financial affairs in order? Will my children be secure? Will I ever meet my grandchildren?
Of course, I was very concerned about my wife. Wed been married 32 years at that point, and I worried about what impact this would have on her. Shes a very strong and good person, and she remained at my side every moment of the time. And that support proved to be invaluable.
How many physicians did you see before making a treatment decision?
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What Happens After The Male Sling Procedure
Following your surgery, you may have a catheter exiting from the urethra for a short period of time. The catheter is in place to allow you to empty your bladder since there may be swelling after surgery that makes it difficult to urinate. After the swelling goes down, you will gradually be able to urinate on your own and empty your bladder well. However, your normal pattern of urination may not return for a few weeks. You can resume a normal diet after surgery.
The Procedure That Got Me Dry Again After Nine Years Of Incontinence
Like many men, Peter Barton had to deal with urinary incontinence after prostate surgery and was among those who dont see the problem improve over time. After years of using pads as the problem got worse, Peter decided to try a surgical treatment the male sling.
PETER: As a fit farmer aged 65 it was a great shock when I was diagnosed with prostate cancer back in 2008. My wife and I examined all the options for treatment and opted for robotic assisted surgery, which was then still in its early development in the UK.
The surgery went well. My excellent urologist had said that wed just got the tumour before it had broken out of the prostate and my family were much relieved as he confirmed the cancer was unlikely to return.
I was out of hospital in two days but had to wear a catheter for two weeks these were pretty miserable weeks. It wasnt painful at all, but it was awkward. It kept getting caught up on things and was constantly leaking. Things improved when the catheter was removed however I was left incontinent.
For the next nine years life was good but, although I followed instructions about pelvic floor exercises, which I know work for some men, my incontinence slowly worsened. For the first year or two I was using a size one pad the lightest. After two years, Id moved on to the number two and by the last few years I was on a number three, which needed changing several times a day. Each of these can hold a considerable amount of urine.
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How Long Does Urinary Incontinence After Prostate Surgery Last
It’s impossible to say exactly how long it lasts. The chances of you having urinary problems may be influenced by your age, weight and the physical characteristics of your urethra .
However, a majority of men are eventually continent after a radical prostatectomy. In many cases, men are able to go safely without any kind of incontinence product after about three months. This is especially true of men who are healthy overall and fall into the age range of 40 to 60 years. If you are having persistent problems, its important to know that there are ways to treat urinary incontinence after prostate surgery.
What To Expect From Your Doctor
Your doctor is likely to ask you a few questions, such as:
- When did you first begin experiencing symptoms, and how severe are they?
- Have your symptoms been continuous or occasional?
- What, if anything, seems to improve or worsen your symptoms?
- How often do you need to urinate?
- When do you leak urine?
- Do you have trouble emptying your bladder?
- Have you noticed blood in your urine?
- Do you smoke?
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