Open Or Laparoscopic Radical Prostatectomy
In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.
In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.
Preparation For Prostatectomy Surgery
During the weeks before the surgery, patients should stop taking anything that prevents blood clotting, including aspirin, ibuprofen, warfarin, vitamin E, and fish oil. Ideally, they should also stop smoking several weeks before surgery so as to help speed recovery.
Patients may also be asked to take a laxative or use an enema on the morning of the surgery to clean out their colon. In addition, the doctor may administer an antibiotic to prevent infection.
Why Is Turp Performed
Your urologist may recommend a TURP to treat an enlarged prostate due to the following conditions:
BPH , which is a noncancerous condition in which the prostate enlarges as a man ages. When the prostate gland grows, it presses against the urethra and bladder. This causes difficulty urinating, incontinence, , and incomplete emptying of the bladder.
, which causes , painful urination, painful ejaculation, and other symptoms. Sometimes a urologist may choose TURP to treat symptoms of prostate in older or ill men who cannot tolerate move invasive surgery to remove the prostate.
Your doctor may only consider A TURP for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a TURP.
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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.
What Are The Limitations Of Prostate Ultrasound Imaging
Men who have had the tail end of their bowel removed during prior surgery are not good candidates for ultrasound of the prostate gland because this type of ultrasound typically requires placing a probe into the rectum. However, the radiologist may attempt to examine the prostate gland by placing a regular ultrasound imaging probe on the perineal skin of the patient, between the legs and behind the scrotum of the patient. Sometimes the gland can be examined by ultrasound this way, but the images may not be as detailed as with the transrectal probe. An MRI of the pelvis may be obtained as an alternative imaging test, because it may be obtained with an external receiver coil.
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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.
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
How Does A Person Prepare To Receive A Prostate Massage
One quick FYI is that prostate massages can make people feel like they have to pee, so the person having their prostate massaged should probably empty their bladder beforehand. Then you and your partner should take deep breaths. Deep breathing activates the bodys relaxation responsewhich is good for everyone involvedand a relaxed anal sphincter is a happy anal sphincter . Keep in mind that the more relaxed and turned on one is, the more comfort and pleasure theyre likely to experience.
Another thing to remember: The physical position may make receiving a prostate massage feel better or more feasible. Its not a guarantee, but some people find that being on top makes anal penetration easier, SELF previously reported. Your partner can kneel with your hand between their legs, for instance. With that said, it will likely take some experimentation to figure out which position feels best for the person receiving a prostate massage.
Day Before Your Surgery
Follow a light diet
Follow a light diet, such as a small sandwich, eggs, toast, crackers, or soup. Limit the amount of dairy products you eat and drink, and avoid fried foods and foods with a lot of seasoning.
Note the time of your surgery
A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, theyll call you on the Friday before. If you dont get a call by 7:00 pm, call .
The staff member will tell you what time to arrive at the hospital for your surgery. Theyll also remind you where to go.
Do your bowel preparation
The night before your surgery, use a saline enema as instructed on the box.
Shower with a 4% CHG solution antiseptic skin cleanser
The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.
Okay Exactly What And Where Is The Prostate
The prostate is a walnut-size gland nestled deep inside the male pelvis, and it helps produce semen and nourish it with important substances, Hong, M.D., a urologist in Phoenix, tells SELF. Cisgender women dont have prostates. But for the folks who do have them, the prostate is made up of tissue known as stroma, secretory glands that produce semen ingredients, and muscle fibers. Its located right in front of the bladderthe ducts in the prostate gland actually flow into the urethra, which is why prostate issues can affect urinary function. For example, if someone has an enlarged prostate , they might find that they have a more frequent urge to pee, among other symptoms, the Mayo Clinic explains.
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Holmium Laser Enucleation Of The Prostate
In a high-tech procedure known as holmium laser enucleation of the prostate, your NYU Langone surgeon uses a laser to remove the prostate tissue that is blocking urine flow, without damaging the surrounding tissue. Performed under general anesthesia in the hospital, this procedure involves removing, or enucleating, prostate tissue that is blocking urine flow by cutting, or morcellating, it into small, easily removable pieces using a laser.
Men who undergo this procedure can expect to recuperate at home and return to work in less than a week. Temporary side effectsincluding blood and burning with urination, an increase in the frequency and urgency of urination, and mild urine leakagecan last for up to four weeks.
During recovery, you can perform most of your usual activities, except for sexual or strenuous activities.
What Is A Transurethral Resection Of The Prostate
The prostate gland is found only in males. It sits below the bladder andwraps around the urethra. The urethra is the tube that carries urine out ofthe body. The prostate helps produce semen.
A transurethral resection of the prostate is surgery to remove partsof the prostate gland through the penis. No incisions are needed.
The surgeon reaches the prostate by putting an instrument into the end ofthe penis and through the urethra. This instrument, called a resectoscope,is about 12 inches long and .5 inch in diameter. It contains a lightedcamera and valves that control irrigating fluid. It also contains anelectrical wire loop that cuts tissue and seals blood vessels. The wireloop is guided by the surgeon to remove the tissue blocking the urethra onepiece at a time. The pieces of tissue are carried by the irrigating fluidinto the bladder and then flushed out at the end of the procedure.
What Is The Most Common Approach
A technique called transurethral resection of the prostate is considered to be the standard surgical approach. This procedure involves inserting a thin tube called a resectoscope into the urethra and guiding it through to the prostate. The resectoscope is equipped with a tiny camera and an electrical loop that is used to mechanically remove prostate tissue. The loop produces heat at the same time, which quickly seals off the blood vessels. The resectoscope also has valves that regulate the release of fluid to flush the removed tissue out. TURP takes about 90 minutes and is done under local or general anesthetic. Men who have had this procedure usually need to have a urinary for a few days after, and generally stay in the hospital for two to seven days. They then have to rest and take it easy for a few weeks.
Some variations of TURP are also considered to be standard treatments and have similar outcomes and consequences to conventional TURP. These include transurethral electrovaporization , transurethral vaporesection and plasmakinetic enucleation of the prostate .
Problems With Sexual Performance
- Ejaculation into the bladder is very common. It occurs in about 25 to 99 men out of 100.footnote 2 This does not affect sexual function.
- Some men report erection problems after this surgery. But it’s not clear if the surgery caused these problems. For men who do have trouble getting an erection, medicine can help.
Holep Rezum And Urolift
Surgical treatments for benign enlargement of the prostate are an option for men with troublesome symptoms who have not had satisfactory results after trying prostate medication, or who do not wish to remain on longterm medication for their prostate condition. Surgery is also used to treat men suffering from urinary retention who are unable to pass urine and are dependent on a catheter to empty their bladder, and for men who have repeated urine infections or bleeding due to their enlarged prostate.
REZUM is the new minimally invasive treatment that uses steam vapour to shrink the prostate and improve urinary symptoms. It is carried as day case and patients are able to return normal daily activity within a few days.
Uro Lift is a new minimally invasive treatment for men with urinary symptoms due to minimal- moderate enlargement of the prostate. It is performed from within the urethra and involves pinning back rather than removing the obstructive prostate tissue. It is not suitable for all men with urinary symptoms and is as yet unproven in the treatment of men with urinary retention. Advice from a specialist urologist, such as those in the Cambridge Urology Partnership, is advised in order to determine whether UroLift might be suitable for you.
How Do I Prepare For My Turp
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for TURP by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a , EKG , blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen , and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctors office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
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What Does The Equipment Look Like
Ultrasound scanners consist of a computer console, video display screen and an attached transducer. The transducer is a small hand-held device that resembles a microphone. Some exams may use different transducers during a single exam. The transducer sends out inaudible, high-frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines.
The technologist applies a small amount of gel to the area under examination and places the transducer there. The gel allows sound waves to travel back and forth between the transducer and the area under examination. The ultrasound image is immediately visible on a video display screen that looks like a computer monitor. The computer creates the image based on the loudness , pitch and time it takes for the ultrasound signal to return to the transducer. It also takes into account what type of body structure and/or tissue the sound is traveling through.
For ultrasound procedures such as transrectal exams that require insertion of an imaging probe, also called a transducer, the device is covered and lubricated with a gel.
What Are The Risks And Potential Complications Of A Turp
As with all surgeries, a TURP involves risks and possible complications. Most TURP procedures are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an and problems with breathing
Bleeding, which can lead to shock
, in particular a that develops in the leg or pelvis. A DVT can travel to your lungs and cause a .
Abnormal flow of semen into the bladder instead of out the urethra
Damage to nearby organs and tissues including the urethra, bladder or rectum
Damage to tissue around the prostate due to buildup of fluid
, which is problems having or keeping an erection
Scar tissue on the urethra, which could tighten the urethra and cause a urethral narrowing, or stricture, making it difficult to urinate
Urinary or bowel incontinence
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, , fever, increase in pain, or decreased urination
Seeing your doctor as instructed before and after surgery
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
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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: