Nerve Sparing Technique For Robotic Prostate Surgery
For patients with prostate cancer there is a new technique to ensure nerve preservation during robotic radical prostatectomy.
Prostate cancer is the most common cancer in men in the UK. It usually develops slowly and symptoms do not necessarily appear for a long time. For many men with prostate cancer, treatment is not needed immediately and in some cases not at all.
For those who do require treatment, options include the surgical removal of the prostate, radiotherapy or brachytherapy.
The nerves for erections are in close proximity to the prostate. If the results of an MRI scan or biopsy indicate that the cancer is next to the prostate, the nerves are likely to be cut out during the procedure. However, following the operation it is frequently found that the cancer was not actually near the nerves and therefore the nerves could have been saved.
To overcome this problem, Mr Senthil Nathan, Consultant Urological and Robotic Surgeon, explains ClinicSafe a pioneering new technique developed by The London Clinic urologists, radiologists andpathologists. This allows the nerves to be preserved during robotic radical prostatectomy, resulting in better continence and erections post-surgery.
Nerves Removed During Prostate Surgery
The only other thing I was drinking in the first 6 months after my diagnosis was green tea. I would drink about 4 glasses of green tea daily to go along with the increased water intake. I wasnt putting any other liquid into my body for the first 6 months. This was a big help in starting my road to recovery.
Once I started feeling better then I added organic soy milk to my diet as well. Soy milk isnt much like regular milk but once you get used to it then its not bad at all. To this day these are the only 3 liquids I have in my diet. To recap the 3 liquids I drink today are purified water,green tea,& organic soy milk. I put no other liquids into my body period.
Now, I want to chat a little more about meat & other aspects of a proper diet. As I said we dont need meat to live. I thought cutting or limiting meat in my diet would be to hard to accomplish. Well again my thinking was wrong. Was it easy? No! However, after a couple weeks then things were starting to get easier. I didnt cut all meats out of my diet but I did cut certain meats & eat moderate amounts of all others.
One meat that needs to be completely cut or at least very minimized is red meat . Too much Red meat consumption is not good for prostate health. I was eating a lot of fast food burgers & also red meat at home. I will say to at least cut red meat completely out of your diet until you get your prostate health back.
While In The Hospital
It’s important to your recovery to start moving as soon as possible. Most men are out of bed and walking around the unit on the same day as their surgery. Your nurse will assist you until you can manage on your own. When you first get up, raise the head of your bed, take a couple of deep breaths, and allow your body to adjust to the change in position. Dangle your feet over the side of the bed for a few minutes, then slowly stand up. Be careful because getting up too quickly can make you light-headed.
Get out of bed at least three times each day preferably more. This helps prevent lung infections and blood clots. You may be prescribed an injectable blood thinner to further reduce the risk of blood clots. The more time you spend out of bed, the faster you will recover and the faster your bowel function will return to normal. Your nurse will also give you an oral stool softener and mild laxative to prevent constipation.
In addition to walking, you will be encouraged to do two other things that help prevent complications: Use an incentive spirometer , and wear compression stockings while in bed. Both will be provided and the nurses will instruct you on how to use them.
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Introduction To Nerve Regeneration
Three sets of nerves are important when a man has sex:
Because of their location, sandwiched between the prostate and the rectum, the second set of nerves can be affected during radical prostatectomy. The other two sets of nerves cannot be affected. Regarding climax after surgery, roughly 80% of men describe climax as being equally satisfying after surgery as before, 10% say that it is better and 10% say that it is less intense.
Preoperative Planning With Multi
Multiparametric magnetic resonance imaging has gained widespread use in the workup of elevated PSA and diagnosis of prostate cancer via MRI-transrectal ultrasound targeted fusion biopsy. This technique has been shown to increase the detection rate of high-grade prostate cancer by 30% and result in lower detection of low grade prostate cancers by 17% . The recently published PROMIS trial evaluated the performance of mpMRI to the reference standard template prostate mapping biopsy and reported superior sensitivity for mpMRI compared to TRUS biopsy and negative predictive value , allowing 24% with negative MRI to safely avoid having to undergo biopsy .
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Staging Of Prostate Cancer
Doctors will use the results of your prostate examination, biopsy and scans to identify the âstageâ of your prostate cancer .
The stage of the cancer will determine which types of treatments will be necessary.
If prostate cancer is diagnosed at an early stage, the chances of survival are generally good.
How Did You Find Out About The Nerve
It took me a while and quite a few conversations with various consultants at different hospitals as it is such a new procedure. One recommended I speak to Mr Nathan at The London Clinic, as he was pioneering this new nerve-sparing technique.
Initially, I spoke to a specialist nurse at the clinic who was terrific and then to Mr Nathan directly to discuss my options. He pointed out that if we were to leave the cancer it would go into my bones and it would spread but if it was removed, I would have a normal life expectancy. With the new ClinicSafe technique, he assured me that he and the team would be able to do everything possible to protect the nerve. He was so confident it completely transformed my way of thinking, so surgery it was.
He wanted a particular pathologist, the reason being when they do the robotic operation, , they take a frozen section and then they can judge if there is cancer in it and if theyve taken enough away.
The consultant came back into the room after the operation and said he was very pleased with how it had gone and to come back in 10 days time. When I did, I found out I was completely cancer free. Of course it can come, back and I still have to have my blood tested every 3 months but if it does come back, I can have radiotherapy.
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Life After Prostate Removal
For many men with prostate cancer, prostate removal is never needed because the cancer is often slow-growing and managed with non-surgical treatments. But, if the cancer has grown beyond the prostate, the oncologist may recommend prostate removal surgery, also called a prostatectomy. If you are going to have prostate removal surgery, this information can help you in your discussion with the doctors.
First Reports On Nerve Grafts
Kim ED, Nath R, Kadmon D, et al. Bilateral Nerve Graft During Radical Retropubic Prostatectomy: 1-Year Follow-Up. Journal of Urology 2001 165:195056. PMID: 11371887.
Kim ED, Nath R, Slawin KM, et al. Bilateral Nerve Grafting During Radical Retropubic Prostatectomy: Extended Follow-Up. Urology 2001 58:98387. PMID: 11744473.
Kim ED, Scardino PT, Hampel O, et al. Interposition of Sural Nerve Restores Function of Cavernous Nerves Resected During Radical Prostatectomy. Journal of Urology 1999 161:18892. PMID: 10037395.
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What Should I Expect When I Get Home
When you are discharged from the ward you will need some baggy trousers or track pants as you may find that your abdomen is uncomfortable and the catheter is easier to manage if your clothing is loose.
There will be some blood, urine, and mucus which passes alongside or through the catheter and is particularly noticeable after passing a bowel motion this is normal. You should wash the area with soap and water to remove this discharge to reduce any irritation. Keeping a high oral fluid intake reduces the risk of catheter blockage.
You may notice some swelling and bruising around the wounds, the penis, and the scrotum which takes several weeks to resolve. You may also notice small firm lumps below the wound these are normal and are simply the knots in the suture material used to close the wound. The suture slowly dissolves and will disappear within 3 months. Most men feel quite tired after surgery and this takes several weeks to resolve.
Following surgery, you will be given a prescription for regular pain medication as well as some laxative medication to keep your bowels regular and thus avoid any straining.
Light walking is encouraged straight after the surgery. After four to six weeks you may resume heavy lifting.
Showering, bathing, and getting the wounds wet is fine the skin has been sealed with glue.
Driving is safe once you are comfortable to do so and feel able to make an emergency stop. This would normally be around 3 weeks following surgery.
How Will Sex After Prostate Cancer Be Different
One of the treatments of prostate cancer is to remove a portion of the prostate or the totality of the gland before cancer spreads beyond it You may have heard that the tumor is inside the capsule, but moving fast.
The procedure is known as radical prostatectomy and involves incisions, either above the perineum or on the lower abdomen.
Newer surgeries are sometimes robot-assisted, and we also have laparoscopic prostatectomies that do not require a large incision.
The end result is the removal of a portion or the totality of the prostate, and certain surgical approaches may be associated with a lower risk of nerve damage than others. Youll see this referred to as nerve-sparing prostatectomies throughout this guide.
As soon as a man is informed that he will need to go through a Radical Prostatectomy, the likelihood is that one of the very first questions will be about the effect that it will have on their sex life. In a lot of mens minds, the surgery is thought of like its castration.
However, now that there are multiple types of nerve-sparing prostate surgery, many men have found they can maintain sexual activity after surgery.
Likewise, there are plenty of sexual activities open to those who do find they still have the desire, even with some physical changes. We want to help you understand the changes that men can experience after prostate surgery, whether that is physical or mental.
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You Can Have A Good Sex Life After Surgery
Its essential to know these two facts, because a lot of men dont hear the whole truth from their doctor or maybe they do hear it, but then focus on statistics for younger men who have never had erectile dysfunction and think the results will be the same for everybody. If you are in your sixties or older, have already experienced some ED, and maybe you also have some other health issues, like diabetes or heart disease, then most likely you will have some ED after surgery. It happens after radiation, as well the onset is more gradual, but the basic problem is the same damage to the nerves and blood supply that control erection .
Erections are going to be altered from what you had before surgery, says Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. Unfortunately, many doctors never provide this information in fact, some men believe that if their erections before surgery are not as rigid as they would like, that a radical prostatectomy may actually improve them. This is definitely not the case. You may go on the Internet and find some doctor who says that 98 percent of his patients are continent and have excellent erections after surgery but nowhere does that doctor tell you that he or she is just reporting on his youngest and best post-op cases, not on every single patient. I cant tell you how many men come to see me and expect the same results. When theyre older and already have some trouble with ED, thats just not going to happen.
Hold that thought.
What Is A Prostatectomy
A common surgical approach to prostatectomy includes making a surgicalincision and removing the prostate gland . This may beaccomplished with either of two methods, the retropubic or suprapubicincision , or a perineum incision .
Prior to having a prostatectomy, it’s often necessary to have aprostate biopsy. Please see this procedure for additional information.
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Removal Of The Catheter
Your catheter will be removed by the clinic nurse at Urology Care Wellington 7-14 days after surgery. This is straightforward. You will be given an antibiotic tablet at the time of catheter removal. Afterward, you will be monitored by the nurse to make sure that you are able to pass urine. She will check your wounds are healing and will discuss the use of pads and pelvic floor exercises.
Most patients have some incontinence when the catheter is taken out and most are pad-free three months after surgery. Over nine out of ten are pad-free after a year. We recommend that you start the pelvic floor exercises as soon as your catheter is removed and repeat them every day.
To be prepared for your catheter removal and any temporary urine leakage, you should ensure that you have your own supply of pads at home prior to attending for catheter removal. Bring two pads to your appointment for catheter removal.
What You Never Lose: The Good News About Sexual Function
While regaining erectile functiom is not possible for all men, it is important to remember that erection is just one part of a satisfying sex life. The other parts remain intact despite prostate cancer surgery. Sexual feelings, sexual fulfillment, climax and the sensation of orgasm are still available without erection.
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Penile Traction Therapy Device
This is one of the new treatments for ED after prostatectomy. Patients are wearing a penile traction device for a set period daily. The therapy can stretch the penis, correct deformities, and restore length.
To manage ED after surgery, talk to a urologist. They can help you pinpoint the exact type of treatment that can curb the nerve pain after prostate surgery and ease the dysfunction.
Help Managing Cancer Treatment Side Effects
The team at Compass Oncology is experienced in helping patients treat prostate cancer and manage the side effects of treatment. If you live in the Portland-Vancouver area, have more questions about the side effects of prostate cancer treatment, or need help managing your side effects, request an appointment at one of our locations that’s convenient for you. We’re here with you every step of the way.
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Risks Of The Procedure
As with any surgical procedure, certain complications can occur. Somepossible complications of both the retropubic and perineal approaches to RPmay include:
Some risks associated with surgery and anesthesia in general include:
Reactions to medications, such as anesthesia
Difficulty with breathing
One risk associated with the retropubic approach is the potential forrectal injury, causing fecal incontinence or urgency.
There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your doctor prior to the procedure.
Advantages Of Ralp Over Traditional Surgery Include:
- Small incisions
- Less blood loss than in traditional surgeries
- Less pain than an open incision surgery
- Less risk of infection over other kinds of surgery
- Shorter stay in the hospital
- Faster recovery at home
The magnification system provides your surgeon with a clear view of the tiny blood vessels, nerves, and muscles surrounding your prostate to help minimize side effects after your surgery.
Not every man who needs prostate removal surgery will be a candidate for robotic surgery. Each prostate cancer patients situation is unique, with some patients requiring a different surgical method either traditional open surgery or, less frequently, radical perineal prostatectomy.
If you have recently been diagnosed with prostate cancer and are looking for a second opinion on treatment options before undergoing surgery, consult with one of the prostate cancer specialists at Compass Oncology located throughout the Portland-Vancouver area.
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What Happens Immediately After Surgery
Once your surgery has finished, you are taken to the recovery room where you will wake up.
There will be a catheter in your bladder and sometimes a small wound drain.
You will often feel a sense of needing to empty your bladder. This is normal and is due to the irritation and spasm of the bladder caused by the catheter. This sensation slowly resolves and medication can be given to help relax the bladder. The catheter is held in place with a 3cm inflatable balloon on the catheter tip so cannot fall out with normal activity. Your catheter will remain in for approximately ten days to allow the new join between your bladder and urethra to heal.
Typically, after one hour in the recovery room, you are taken back to the ward. You will be able to sit up in bed and eat dinner on the evening of surgery and walk about the ward that day or the following morning. Blood thinners and calf compressors are used to reduce the risk of blood clots forming within the veins. Post-operative pain is well controlled through the use of regular pain medication. Once you are comfortable and confident in caring for the catheter you can head home. Hospital stay is typically 1-2 nights for robotic surgery and 2-3 nights for open surgery.